Provider Demographics
NPI:1063492650
Name:HERBERT, RALPH WAYNE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:WAYNE
Last Name:HERBERT
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:R. WAYNE
Other - Middle Name:
Other - Last Name:HERBERT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:9600 BAPTIST HEALTH DR
Mailing Address - Street 2:SUITE 360
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6326
Mailing Address - Country:US
Mailing Address - Phone:501-227-6727
Mailing Address - Fax:501-223-9463
Practice Address - Street 1:9600 BAPTIST HEALTH DR
Practice Address - Street 2:SUITE 360
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6326
Practice Address - Country:US
Practice Address - Phone:501-227-6727
Practice Address - Fax:501-223-9463
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR2746208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR105166001Medicaid
AR105166001Medicaid
AR52341Medicare ID - Type UnspecifiedMEDICARE/BLUE CROSS #