Healthcare Provider Details

I. General information

NPI: 1861419632
Provider Name (Legal Business Name): ANNIE T LUY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 E RACE AVE
SEARCY AR
72143-4659
US

IV. Provider business mailing address

PO BOX 1424
SEARCY AR
72145-1424
US

V. Phone/Fax

Practice location:
  • Phone: 501-279-1472
  • Fax: 501-268-4385
Mailing address:
  • Phone: 501-279-1472
  • Fax: 501-268-4385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberE0465
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: