Individual
DR. LACKEY GENE MOODY
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1301 WHITE DR, BATESVILLE, AR 72501-9467
(870) 793-6887
(870) 793-8085
Mailing address
PO BOX 2335, BATESVILLE, AR 72503-2335
(870) 793-6887
(870) 793-8085
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
C-4126
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
53736
BLUE CROSS OF AR
AR
Enumeration date
03/24/2006
Last updated
07/08/2007
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