Doctor Name: | MR. JEFFERY LANE ULMER |
NPI Number: | 1225072614 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | P.A.-C. |
License Number: | PA-116 |
Business Practice Address: | 1102 Crestwood Cir Mena, AR - 719535513 |
Business Phone Number: | 4793947301 |
Business Fax Number: | 4793947160 |
Mailing Address: | 1102 Crestwood Cir, MENA |
State: | AR |
Postal Code: | 719535513 |
Phone Number: | 4793947301 |
Fax Number: | 4793947160 |
NPI Enumeration Date: | 06/15/2006 |
NPI Last Update Date: | 12/23/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | PA-116 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AR |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |