Healthcare Provider Details

I. General information

NPI: 1316106727
Provider Name (Legal Business Name): PULTRO & PALMER, P. A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2008
Last Update Date: 06/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N QUANAH AVE
RUSSELLVILLE AR
72801-2762
US

IV. Provider business mailing address

500 S UNIVERSITY AVE SUITE 405
LITTLE ROCK AR
72205-5302
US

V. Phone/Fax

Practice location:
  • Phone: 479-968-7250
  • Fax:
Mailing address:
  • Phone: 501-664-5511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberA151
License Number StateAR

VIII. Authorized Official

Name: DR. CHARLES PALMER
Title or Position: AUDIOLOGIST
Credential: AUD.
Phone: 479-968-7250