Individual
LARRY E. JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2200 FORT ROOTS DR, VA GERIATRICS SERVICE 94/NLR, NORTH LITTLE ROCK, AR 72114-1709
(501) 257-2668
Mailing address
2200 FORT ROOTS DR, VA GERIATRICS SERVICE 94/NLR, NORTH LITTLE ROCK, AR 72114-1709
(501) 257-2668
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
E-1972
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5L008
PROVIDER NUMBER
AR
Enumeration date
07/31/2006
Last updated
04/08/2008
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