Healthcare Provider Details

I. General information

NPI: 1346508470
Provider Name (Legal Business Name): GERREN HOBBY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2012
Last Update Date: 08/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4802 E JOHNSON AVE
JONESBORO AR
72401-6240
US

IV. Provider business mailing address

PO BOX 1960
JONESBORO AR
72403-1960
US

V. Phone/Fax

Practice location:
  • Phone: 870-936-8000
  • Fax: 870-934-3640
Mailing address:
  • Phone: 870-936-8000
  • Fax: 870-934-3640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberE11104
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: