Provider Demographics
NPI:1134363716
Name:WALSER, BRANDON (MD)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:
Last Name:WALSER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 SAINT VINCENT CIR
Mailing Address - Street 2:SUITE 160
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5405
Mailing Address - Country:US
Mailing Address - Phone:501-661-0037
Mailing Address - Fax:501-661-0038
Practice Address - Street 1:1 SAINT VINCENT CIR
Practice Address - Street 2:SUITE 160
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5405
Practice Address - Country:US
Practice Address - Phone:501-661-0037
Practice Address - Fax:501-661-0038
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-27
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE7675207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR205150001Medicaid
AR205150001Medicaid