Healthcare Provider Details

I. General information

NPI: 1184968406
Provider Name (Legal Business Name): JAMES FLOYD KYSER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2012
Last Update Date: 11/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 N SPRUCE ST
LITTLE ROCK AR
72207-4731
US

IV. Provider business mailing address

2211 N SPRUCE ST
LITTLE ROCK AR
72207-4731
US

V. Phone/Fax

Practice location:
  • Phone: 501-664-4455
  • Fax: 501-664-4454
Mailing address:
  • Phone: 501-664-4455
  • Fax: 501-554-4454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberC-3108
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: