Healthcare Provider Details

I. General information

NPI: 1811968092
Provider Name (Legal Business Name): RUSSELL L CRANFORD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 07/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11719 HINSON ROAD SUITE 110
LITTLE ROCK AR
72212-3402
US

IV. Provider business mailing address

11001 EXECUTIVE CENTER DR STE 200
LITTLE ROCK AR
72211-4393
US

V. Phone/Fax

Practice location:
  • Phone: 501-224-2875
  • Fax: 501-221-9251
Mailing address:
  • Phone: 501-812-7800
  • Fax: 501-812-7777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC 5042
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC-5042
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: