Provider Demographics
NPI:1457493140
Name:JAMES A. METRAILER, MD PA
Entity Type:Organization
Organization Name:JAMES A. METRAILER, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:TITSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-812-7512
Mailing Address - Street 1:904 AUTUMN RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3702
Mailing Address - Country:US
Mailing Address - Phone:501-603-2244
Mailing Address - Fax:501-603-0303
Practice Address - Street 1:1100 N UNIVERSITY AVE STE 102
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72207-6351
Practice Address - Country:US
Practice Address - Phone:501-603-2244
Practice Address - Fax:501-603-0303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC5078174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5F271Medicare ID - Type UnspecifiedPROVIDER NUMBER