Provider Demographics
NPI:1851505358
Name:HEARNE, ARCHIE (MD)
Entity Type:Individual
Prefix:
First Name:ARCHIE
Middle Name:
Last Name:HEARNE
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 1:1001 WRIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72206-1062
Mailing Address - Country:US
Mailing Address - Phone:501-224-2800
Mailing Address - Fax:501-224-2829
Practice Address - Street 1:1001 WRIGHT AVE
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72206-1062
Practice Address - Country:US
Practice Address - Phone:501-224-2800
Practice Address - Fax:501-224-2829
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARN-6227207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR770156901Medicaid
AR770156901Medicaid
AR52295Medicare PIN