Healthcare Provider Details

I. General information

NPI: 1427297902
Provider Name (Legal Business Name): W L RUTLEDGE MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2009
Last Update Date: 03/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9712 W MARKHAM ST
LITTLE ROCK AR
72205-2124
US

IV. Provider business mailing address

1501 N UNIVERSITY AVE SUITE 500
LITTLE ROCK AR
72207-5242
US

V. Phone/Fax

Practice location:
  • Phone: 501-225-3384
  • Fax:
Mailing address:
  • Phone: 501-661-8207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR3422
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberR3422
License Number StateAR

VIII. Authorized Official

Name: DR. WILLIAM L RUTLEDGE
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 501-225-3384