Provider Demographics
NPI:1619947298
Name:PERSER, ELWYN JOE (MD)
Entity Type:Individual
Prefix:DR
First Name:ELWYN
Middle Name:JOE
Last Name:PERSER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7 OFFICE PARK
Mailing Address - Street 2:SUITE 100 FAMILY PRACTICE
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-5610
Mailing Address - Country:US
Mailing Address - Phone:501-225-9222
Mailing Address - Fax:501-225-8564
Practice Address - Street 1:7 OFFICE PARK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3843
Practice Address - Country:US
Practice Address - Phone:501-225-9222
Practice Address - Fax:501-225-8564
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE-2350207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5L339Medicare ID - Type Unspecified
ARH06101Medicare UPIN