Provider Demographics
NPI:1265642862
Name:AYERS, VINCENT JEROME (LCRP)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:JEROME
Last Name:AYERS
Suffix:
Gender:M
Credentials:LCRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3621 SUNFLOWER DR
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:AR
Mailing Address - Zip Code:72104-2134
Mailing Address - Country:US
Mailing Address - Phone:501-318-9548
Mailing Address - Fax:
Practice Address - Street 1:431 W OAK ST
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-4566
Practice Address - Country:US
Practice Address - Phone:870-864-9190
Practice Address - Fax:870-864-9191
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1341227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified