Basic Information
| Provider Information | |||||||||
| NPI: | 1134111099 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCLEOD | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | I | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2910 CYPRESS RD | ||||||||
| Address2: | |||||||||
| City: | ARKADELPHIA | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719234227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8702465097 | ||||||||
| FaxNumber: | 8702469693 | ||||||||
| Practice Location | |||||||||
| Address1: | 2910 CYPRESS RD | ||||||||
| Address2: | |||||||||
| City: | ARKADELPHIA | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719234227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8702465097 | ||||||||
| FaxNumber: | 8702469693 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2005 | ||||||||
| LastUpdateDate: | 05/23/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | R4012 | AR | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 276804 | 01 | AR | HEALTHLINK | OTHER | 116444001 | 05 | AR | MEDICAID | 5932105 | 01 | AR | AETNA | OTHER |