MEDICARE: BRENDA G. KETCHER M.D.,P.A.

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	207RG0100X	Gastroenterology Physician	C8125	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	5J570	OTHER	AR	BCBS

General Provider Information

NPI Number	:	1588666143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA G. KETCHER M.D.,P.A.

Provider Business Mailing Address
First Line	:	124 SAWTOOTH OAK ST
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71901-7160
Country	:	US
Telephone Number	:	501-623-7800
Fax Number	:	501-623-7866

Provider Business Practice Location Address
First Line	:	124 SAWTOOTH OAK ST
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71901-7160
Country	:	US
Telephone Number	:	501-623-7800
Fax Number	:	501-623-7866

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

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	07/02/2014

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Directions to “ BRENDA G. KETCHER M.D.,P.A.” Practice Location

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