MEDICARE: SEPTEMBER WESTBROOK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	E0331	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	14486000000	OTHER	AR	QUALCHOICE
3	4601222	OTHER	AR	AETNA
4	390914	OTHER	AR	HEALTHLINK

General Provider Information

NPI Number	:	1093779415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEPTEMBER WESTBROOK MD

Provider Business Mailing Address
First Line	:	904 AUTUMN RD SUITE 100
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72211-3742
Country	:	US
Telephone Number	:	501-224-5437
Fax Number	:	501-224-3473

Provider Business Practice Location Address
First Line	:	904 AUTUMN RD SUITE 100
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72211-3742
Country	:	US
Telephone Number	:	501-224-5437
Fax Number	:	501-224-3473

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2006
Last Update Date	:	11/03/2011

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Directions to “ SEPTEMBER WESTBROOK MD” Practice Location

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