Healthcare Provider Details

I. General information

NPI: 1033261680
Provider Name (Legal Business Name): JONATHAN AMARKWEI LARYEA MB CHB
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 09/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 W MARKHAM ST SLOT 520
LITTLE ROCK AR
72205-7101
US

IV. Provider business mailing address

4301 W MARKHAM ST SLOT 520
LITTLE ROCK AR
72205-7101
US

V. Phone/Fax

Practice location:
  • Phone: 501-686-6648
  • Fax: 501-686-7280
Mailing address:
  • Phone: 501-686-6648
  • Fax: 501-686-7280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number043833
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberE5656
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: