MEDICARE: PEGGY KENLEY GUARD M.D.

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	207VG0400X	Gynecology Physician	C 8487	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

General Provider Information

NPI Number	:	1942278247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PEGGY KENLEY GUARD M.D.

Provider Business Mailing Address
First Line	:	9501 BAPTIST HEALTH DR
Second Line	:	STE 777
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-6225
Country	:	US
Telephone Number	:	501-801-7900
Fax Number	:	501-801-7905

Provider Business Practice Location Address
First Line	:	9601 LILE DR
Second Line	:	STE 400
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-6321
Country	:	US
Telephone Number	:	501-978-4340
Fax Number	:	501-227-5187

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

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	01/08/2014

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