Individual
DR. TERRY GRANT FLETCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD PHD
Contact information
Practice address
108 N SHACKLEFORD RD, LITTLE ROCK, AR 72211-2840
(501) 712-2571
Mailing address
108 N SHACKLEFORD RD, LITTLE ROCK, AR 72211-2840
(501) 712-2571
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
E-5050
AR
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
E-5050
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
163885001
—
AR
01
—
5N783
AR BLUE CROSS/BLUE SHIELD
AR
01
—
P00412911
RAILROAD MEDICARE
AR
Enumeration date
01/18/2007
Last updated
04/05/2022
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