Provider Demographics
NPI:1558304659
Name:RILEY, W K (MD)
Entity type:Individual
Prefix:DR
First Name:W
Middle Name:K
Last Name:RILEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1308 E KIEHL AVE
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72120-3040
Mailing Address - Country:US
Mailing Address - Phone:501-835-0703
Mailing Address - Fax:501-834-6249
Practice Address - Street 1:1308 E KIEHL AVE
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120-3040
Practice Address - Country:US
Practice Address - Phone:501-835-0703
Practice Address - Fax:501-834-6249
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARC-5230207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR0120355OtherUHC
AR4207517OtherAETNA
AR54404OtherBLUE CROSS
AR11172000040OtherQUALCHOICE
AR104835001Medicaid
AR284985OtherHEALTHLINK
AR104835001Medicaid
AR284985OtherHEALTHLINK
AR080053173Medicare PIN
AR4207517OtherAETNA