Provider Demographics
NPI:1518009000
Name:ALBERTY, BRETT LANE (MD)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:LANE
Last Name:ALBERTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:BRETT
Other - Middle Name:LANE
Other - Last Name:ALBERTY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:9601 LILE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6321
Mailing Address - Country:US
Mailing Address - Phone:501-224-5666
Mailing Address - Fax:501-228-2007
Practice Address - Street 1:9601 LILE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6321
Practice Address - Country:US
Practice Address - Phone:501-224-5666
Practice Address - Fax:501-228-2007
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAPPLIED FOR208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOBS5741663OtherMISSOURI DEA #