Individual
LARRY BRUCE BRASHEARS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1517 S MAIN ST, MALVERN, AR 72104
(501) 332-7525
Mailing address
1661 AIRPORT RD STE D, HOT SPRINGS, AR 71913-8184
(501) 625-7500
(501) 625-7777
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
C3174
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102624001
—
AR
01
—
50610
BLUE CROSS BLUE SHIELD
AR
01
—
C-3174
ASMB MEDICAL LICENSE
AR
Enumeration date
07/23/2006
Last updated
01/08/2020
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