Provider Demographics
NPI:1871708180
Name:LANKFORD, LADARYL (M D)
Entity type:Individual
Prefix:DR
First Name:LADARYL
Middle Name:
Last Name:LANKFORD
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 W MAPLE AVE
Mailing Address - Street 2:HOSPITALIST OFFICE
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-5335
Mailing Address - Country:US
Mailing Address - Phone:479-757-5282
Mailing Address - Fax:479-727-2977
Practice Address - Street 1:609 W MAPLE AVE
Practice Address - Street 2:HOSPITALIST OFFICE
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-5335
Practice Address - Country:US
Practice Address - Phone:479-757-5282
Practice Address - Fax:479-727-2977
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ART2007-068207Q00000X
ARE-5264208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ART2007-068OtherTEMP STATE LICENSE
AR172277001Medicaid
OK200194070AMedicaid
AR172277001Medicaid