Healthcare Provider Details

I. General information

NPI: 1710943048
Provider Name (Legal Business Name): JAMES A. METRAILER SR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 07/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 N. UNIVERSITY AVE SUITE 102
LITTLE ROCK AR
72207
US

IV. Provider business mailing address

1100 N. UNIVERSITY AVE SUITE 102
LITTLE ROCK AR
72207
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 Code207RG0100X
TaxonomyGastroenterology Physician
License NumberC5078
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: