Provider Demographics
NPI:1295776045
Name:PLEDGER, NORMAN R (MD)
Entity type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:R
Last Name:PLEDGER
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 1:5207 E BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72117-4029
Mailing Address - Country:US
Mailing Address - Phone:501-945-2033
Mailing Address - Fax:501-945-2303
Practice Address - Street 1:5207 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-4029
Practice Address - Country:US
Practice Address - Phone:501-945-2033
Practice Address - Fax:501-945-2303
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR2917207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR080151573OtherRR MEDICARE
AR139621002Medicaid
AR57573OtherBCBS
AR104872001Medicaid
AR710833071OtherTAX ID NUMBER
AR57573OtherBCBS
AR710833071OtherTAX ID NUMBER