Provider Demographics
NPI:1033261680
Name:LARYEA, JONATHAN AMARKWEI (MB CHB)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:AMARKWEI
Last Name:LARYEA
Suffix:
Gender:M
Credentials:MB CHB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4301 W MARKHAM ST
Mailing Address - Street 2:SLOT 520
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-7101
Mailing Address - Country:US
Mailing Address - Phone:501-686-6648
Mailing Address - Fax:501-686-7280
Practice Address - Street 1:4301 W MARKHAM ST
Practice Address - Street 2:SLOT 520
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-7101
Practice Address - Country:US
Practice Address - Phone:501-686-6648
Practice Address - Fax:501-686-7280
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT043833208600000X
ARE5656208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR169638001Medicaid
AR169638001Medicaid