Provider Demographics
NPI:1427297902
Name:W L RUTLEDGE MD PA
Entity type:Organization
Organization Name:W L RUTLEDGE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:RUTLEDGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-225-3384
Mailing Address - Street 1:1501 N UNIVERSITY AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72207-5242
Mailing Address - Country:US
Mailing Address - Phone:501-661-8207
Mailing Address - Fax:
Practice Address - Street 1:9712 W MARKHAM ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-2124
Practice Address - Country:US
Practice Address - Phone:501-225-3384
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-06
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR3422207Q00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR105362001Medicaid
AR1003820036OtherINDIVIDUAL NPI
AR105362001Medicaid
AR54638G080Medicare PIN