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General NPI Number Information
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NPI Number | 1053334144
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Entity Type | Individual
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Provider Name | KIPTON LUKE GARRETT MD
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Gender | Male
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1100 N COLLEGE AVE
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-1944
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Country | US
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Telephone | 479-443-4301
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Fax |
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Provider Business Mailing Address
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Address Line | 1822 HERITAGE DR
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City | VAN BUREN
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State | AR
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Zip | 72956-2827
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Country | US
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Telephone | 479-471-7174
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | E-1257
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License Number State | AR
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