Healthcare Provider Details

I. General information

NPI: 1730297979
Provider Name (Legal Business Name): LEE CECIL RALEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 05/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 N UNIVERSITY AVE SUITE 203
LITTLE ROCK AR
72205-2936
US

IV. Provider business mailing address

701 N UNIVERSITY AVE SUITE 203
LITTLE ROCK AR
72205-2936
US

V. Phone/Fax

Practice location:
  • Phone: 501-664-2434
  • Fax: 501-907-7768
Mailing address:
  • Phone: 501-664-2434
  • Fax: 501-907-7768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberE-4941
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: