Provider Demographics
NPI:1417922667
Name:LOCHALA, RODDY SMART (DO)
Entity Type:Individual
Prefix:DR
First Name:RODDY
Middle Name:SMART
Last Name:LOCHALA
Suffix:
Gender:M
Credentials:DO
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 1960
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72403-1960
Mailing Address - Country:US
Mailing Address - Phone:870-936-8000
Mailing Address - Fax:870-934-3610
Practice Address - Street 1:1500 MCLAIN
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:AR
Practice Address - Zip Code:72112-3638
Practice Address - Country:US
Practice Address - Phone:870-523-9337
Practice Address - Fax:870-217-0312
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE2255207Q00000X
ARE-2255207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR080191107OtherTRAVELERS MEDICARE
AR5L240OtherMEDICARE PROVIDER NUMBER
AR137047003Medicaid
ARG98051Medicare UPIN
AR5L240OtherMEDICARE PROVIDER NUMBER
AR137047003Medicaid