Provider Demographics
NPI:1164466603
Name:BRANCH, HAROLD WILKES JR (MD)
Entity Type:Individual
Prefix:MR
First Name:HAROLD
Middle Name:WILKES
Last Name:BRANCH
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 783
Mailing Address - Street 2:
Mailing Address - City:BEEBE
Mailing Address - State:AR
Mailing Address - Zip Code:72012-0783
Mailing Address - Country:US
Mailing Address - Phone:501-882-3388
Mailing Address - Fax:501-882-3300
Practice Address - Street 1:47 HIGHWAY 64 W
Practice Address - Street 2:
Practice Address - City:BEEBE
Practice Address - State:AR
Practice Address - Zip Code:72012-9500
Practice Address - Country:US
Practice Address - Phone:501-882-3388
Practice Address - Fax:501-882-3300
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE3831207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR03120012000OtherQUALCHOICE
AR652514OtherHEALTHLINK
AR152434001Medicaid
AR100212OtherUNITED HEALTHCARE
AR7839508OtherAETNA
AR5M772Medicare PIN
AR652514OtherHEALTHLINK
AR03120012000OtherQUALCHOICE