Healthcare Provider Details

I. General information

NPI: 1457493140
Provider Name (Legal Business Name): JAMES A. METRAILER, MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 N UNIVERSITY AVE STE 102
LITTLE ROCK AR
72207-6351
US

IV. Provider business mailing address

904 AUTUMN RD SUITE 500
LITTLE ROCK AR
72211-3702
US

V. Phone/Fax

Practice location:
  • Phone: 501-603-2244
  • Fax: 501-603-0303
Mailing address:
  • Phone: 501-603-2244
  • Fax: 501-603-0303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberC5078
License Number StateAR

VIII. Authorized Official

Name: KIM TITSWORTH
Title or Position: ADMINISTRATOR
Credential:
Phone: 501-812-7512