Provider Demographics
NPI:1285628065
Name:HARGROVE, JOE L (MD)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:L
Last Name:HARGROVE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5315 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-1858
Mailing Address - Country:US
Mailing Address - Phone:501-664-0941
Mailing Address - Fax:501-666-3956
Practice Address - Street 1:5315 W 12TH ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-1858
Practice Address - Country:US
Practice Address - Phone:501-664-0941
Practice Address - Fax:501-666-3956
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR2720207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR104904001Medicaid
ARBH0843955OtherDEA
AR52135Medicare ID - Type Unspecified
ARB90265Medicare UPIN