Healthcare Provider Details

I. General information

NPI: 1245227057
Provider Name (Legal Business Name): GORDON R PARHAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 01/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3215 N NORTHHILLS BLVD
FAYETTEVILLE AR
72703-4424
US

IV. Provider business mailing address

PO BOX 550
LOWELL AR
72745-0550
US

V. Phone/Fax

Practice location:
  • Phone: 479-463-7102
  • Fax: 479-463-7864
Mailing address:
  • Phone: 479-463-7775
  • Fax: 479-463-7187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC5999
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberC-5999
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: