Provider Demographics
NPI:1972563773
Name:LAREY, MARK EUGENE (DO)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:EUGENE
Last Name:LAREY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21850
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71903-1850
Mailing Address - Country:US
Mailing Address - Phone:501-525-9675
Mailing Address - Fax:501-525-7059
Practice Address - Street 1:100 MCGOWAN CT
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS NATIONAL PARK
Practice Address - State:AR
Practice Address - Zip Code:71913-6452
Practice Address - Country:US
Practice Address - Phone:501-525-9675
Practice Address - Fax:501-525-7059
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARN8422207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR124240003Medicaid
E59370Medicare UPIN
E59370Medicare UPIN