Basic Information
| Provider Information | |||||||||
| NPI: | 1487904009 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EMERGENCY MEDICINE OF ARKANSAS PLLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | LAFFERTY FAMILY CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1706 SE WALTON BLVD | ||||||||
| Address2: | SUITE 4 | ||||||||
| City: | BENTONVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727123200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4794640400 | ||||||||
| FaxNumber: | 4792685688 | ||||||||
| Practice Location | |||||||||
| Address1: | 1706 SE WALTON BLVD | ||||||||
| Address2: | SUITE 4 | ||||||||
| City: | BENTONVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727123200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4794640400 | ||||||||
| FaxNumber: | 4792685688 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2012 | ||||||||
| LastUpdateDate: | 10/31/2014 | ||||||||
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| AuthorizedOfficialLastName: | LAFFERTY | ||||||||
| AuthorizedOfficialFirstName: | WARREN | ||||||||
| AuthorizedOfficialMiddleName: | SCOTT | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4794640400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.