Provider Demographics
NPI:1437129780
Name:SOMERS, ANDREW JACK (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:JACK
Last Name:SOMERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 AUTUMN RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3737
Mailing Address - Country:US
Mailing Address - Phone:501-227-6363
Mailing Address - Fax:501-227-8629
Practice Address - Street 1:904 AUTUMN RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3737
Practice Address - Country:US
Practice Address - Phone:501-227-6363
Practice Address - Fax:501-227-8629
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARC5237207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR104838001Medicaid
ARE16759Medicare UPIN
AR550406813Medicare PIN