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NPI Code Detail

MEDICARE: DR. TERRY GRANT FLETCHER MD PHD

MEDICARE: DR. TERRY GRANT FLETCHER MD PHD
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
1207L00000XAnesthesiology PhysicianE-5050AR
2207LP2900XPain Medicine (Anesthesiology) PhysicianE-5050AR

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3P00412911OTHERARRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15N783OTHERARAR BLUE CROSS/BLUE SHIELD
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1851443832
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TERRY GRANT FLETCHER MD PHD
Provider Business Mailing Address
First Line : 108 N SHACKLEFORD RD
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72211-2840
Country : US
Telephone Number : 501-712-2571
Fax Number :
Provider Business Practice Location Address
First Line : 108 N SHACKLEFORD RD
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72211-2840
Country : US
Telephone Number : 501-712-2571
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/18/2007
Last Update Date : 04/05/2022

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