MEDICARE: LAWRENCE C. AULT,III, M.D. PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	N-7862	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255530143
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAWRENCE C. AULT,III, M.D. PA

Provider Business Mailing Address
First Line	:	2400 CRESTWOOD RD
Second Line	:	SUITE 101
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-7067
Country	:	US
Telephone Number	:	501-791-3450
Fax Number	:	501-791-6855

Provider Business Practice Location Address
First Line	:	2400 CRESTWOOD RD
Second Line	:	SUITE 101
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-7067
Country	:	US
Telephone Number	:	501-791-3450
Fax Number	:	501-791-6855

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. KAREN LYNN AULT
Credential	:	R.N.
Telephone Number	:	501-791-3450

Provider Enumeration Date	:	07/12/2007
Last Update Date	:	07/12/2007

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