Healthcare Provider Details

I. General information

NPI: 1417941550
Provider Name (Legal Business Name): LUTHER RHETT WALLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/05/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MERCY LN SUITE 406
HOT SPRINGS AR
71913-6442
US

IV. Provider business mailing address

1 MERCY LN SUITE 406
HOT SPRINGS AR
71913-6442
US

V. Phone/Fax

Practice location:
  • Phone: 501-624-5466
  • Fax: 501-624-0681
Mailing address:
  • Phone: 501-624-5466
  • Fax: 501-624-0681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberR3531
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: