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General NPI Number Information
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NPI Number | 1801904602
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Entity Type | Organization
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Legal Business Name | LB BRASHEARS, MD, LTD
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1234 S MAIN ST
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City | MALVERN
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State | AR
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Zip | 72104-5226
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Country | US
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Telephone | 501-332-5245
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Fax | 501-337-4137
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Provider Business Mailing Address
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Address Line | 1234 S MAIN ST
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City | MALVERN
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State | AR
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Zip | 72104-5226
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Country | US
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Telephone | 501-332-5245
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Fax | 501-337-4137
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. LARRY BRASHEARS
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Credential | MD
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Telephone | 501-332-5245
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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