Provider Demographics
NPI:1770635047
Name:WEATHERS, LARRY W (MD)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:W
Last Name:WEATHERS
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2708 RIFE MEDICAL LN
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-1452
Mailing Address - Country:US
Mailing Address - Phone:479-338-4400
Mailing Address - Fax:479-338-4445
Practice Address - Street 1:2708 RIFE MEDICAL LN
Practice Address - Street 2:SUITE 220
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-1452
Practice Address - Country:US
Practice Address - Phone:479-338-4400
Practice Address - Fax:479-338-4445
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2014-07-15
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Provider Licenses
StateLicense IDTaxonomies
ARR2535207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARB90568Medicare UPIN
AR106541002Medicaid
AR106529001Medicaid
AR55530Medicare PIN