Provider Demographics
NPI:1679822944
Name:CO, JOSEPHINE
Entity Type:Individual
Prefix:DR
First Name:JOSEPHINE
Middle Name:
Last Name:CO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 MENDEN LN
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-9287
Mailing Address - Country:US
Mailing Address - Phone:501-821-0086
Mailing Address - Fax:
Practice Address - Street 1:5 MENDEN LN
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-9287
Practice Address - Country:US
Practice Address - Phone:501-821-0086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-02
Last Update Date:2012-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-3456208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics