Individual provider · NPI-1

Audie Ray Aderholt III, M.D.

Internal Medicine · Little Rock, AR

NPI number1366861601
StatusActive
Last updated in NPPESOct 4, 2019

Details

NPI
1366861601
Entity type
Individual (NPI-1)
Name
Audie Ray Aderholt III
Credential
M.D.
Sex
Male
Sole proprietor
Yes
Enumeration date
Apr 15, 2014
Last updated
Oct 4, 2019

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207R00000X Internal MedicineE-10611ARYes

Practice location

4301 W Markham St
Little Rock, AR 72205-7101

Phone 662-902-9309

Mailing address

4301 W Markham St
Little Rock, AR 72205-7101

Phone 662-902-9309

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