Healthcare Provider Details

I. General information

NPI: 1386633691
Provider Name (Legal Business Name): LAWRENCE HOWARD MEYER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 MEDICAL CENTER PARKWAY
CLINTON AR
72031
US

IV. Provider business mailing address

PO BOX 1060
MARSHALL AR
72650-1060
US

V. Phone/Fax

Practice location:
  • Phone: 501-745-7888
  • Fax: 501-745-4401
Mailing address:
  • Phone: 870-448-5733
  • Fax: 870-448-3392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC7721
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: