Individual
DR. MARCUS PETER KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4301 W MARKHAM ST, MAIL SLOT 555, LITTLE ROCK, AR 72205-7199
(501) 686-5525
(501) 686-7893
Mailing address
4301 W MARKHAM ST, MAIL SLOT 555, LITTLE ROCK, AR 72205-7199
(501) 686-5525
(501) 686-7893
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
E-5260
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07090022400
QUALCHOICE
AR
01
—
5N843
BCBS
AR
01
—
P00405677
RAILROAD MEDICARE
AR
Enumeration date
01/30/2007
Last updated
01/10/2008
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