Provider Demographics
NPI:1821084427
Name:BRUYNEEL, MARIE FRANCINE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:FRANCINE
Last Name:BRUYNEEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9601 BAPTIST HEALTH DR.
Mailing Address - Street 2:SUITE 690
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6328
Mailing Address - Country:US
Mailing Address - Phone:501-227-8422
Mailing Address - Fax:501-537-2399
Practice Address - Street 1:9601 BAPTIST HEALTH DR
Practice Address - Street 2:SUITE 690
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6328
Practice Address - Country:US
Practice Address - Phone:501-227-8422
Practice Address - Fax:501-537-2399
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE0725207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR070008450OtherRAIL ROAD MEDICARE
AR135095001Medicaid
AR135095001Medicaid
AR5J978Medicare PIN