Provider Demographics
NPI:1497752638
Name:BUCOLO, ANTHONY PHILLIP JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:PHILLIP
Last Name:BUCOLO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:10001 LILE DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6217
Mailing Address - Country:US
Mailing Address - Phone:501-552-6100
Mailing Address - Fax:501-552-6199
Practice Address - Street 1:10001 LILE DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6217
Practice Address - Country:US
Practice Address - Phone:501-552-6100
Practice Address - Fax:501-552-6199
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARN-5701207RH0003X
ARN5701174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Not Answered174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR104832001Medicaid
ARN5701OtherLICENSE NUMBER
AR50742Medicare ID - Type UnspecifiedMEDICAR NUMBER