Provider Demographics
NPI:1275556334
Name:LAULE, ALICE R (MD)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:R
Last Name:LAULE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 444
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72654-0444
Mailing Address - Country:US
Mailing Address - Phone:870-424-4900
Mailing Address - Fax:870-424-4979
Practice Address - Street 1:105 SAWGRASS PT
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-3072
Practice Address - Country:US
Practice Address - Phone:870-741-1910
Practice Address - Fax:870-741-6331
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC5133174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARB90381Medicare UPIN
AR53066Medicare ID - Type Unspecified