Provider Demographics
NPI:1366454969
Name:GOATCHER, RHETA JOANN HORTON (MD)
Entity Type:Individual
Prefix:DR
First Name:RHETA
Middle Name:JOANN HORTON
Last Name:GOATCHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JOANN
Other - Middle Name:H
Other - Last Name:GOATCHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:11001 EXECUTIVE CENTER DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4316
Mailing Address - Country:US
Mailing Address - Phone:501-812-7800
Mailing Address - Fax:
Practice Address - Street 1:14300 CHENAL PKWY
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-5805
Practice Address - Country:US
Practice Address - Phone:501-202-1664
Practice Address - Fax:501-202-1685
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR4062207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR119064001Medicaid
AR54570Medicare ID - Type Unspecified
ARE77728Medicare UPIN