Provider Demographics
NPI:1639118391
Name:LAFFERTY, WARREN SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:WARREN
Middle Name:SCOTT
Last Name:LAFFERTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 SE WALTON BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-3201
Mailing Address - Country:US
Mailing Address - Phone:479-464-0400
Mailing Address - Fax:
Practice Address - Street 1:1706 SE WALTON BLVD STE 4
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-3201
Practice Address - Country:US
Practice Address - Phone:479-464-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-0988207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR130105001Medicaid
ARG33370Medicare UPIN
AR5K202Medicare ID - Type Unspecified
ARP00208315Medicare ID - Type UnspecifiedMEDICARE RAILROAD