Healthcare Provider Details

I. General information

NPI: 1871912204
Provider Name (Legal Business Name): DONALD GAULDIN JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2014
Last Update Date: 03/18/2022
Certification Date: 03/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 N RODNEY PARHAM RD STE C-1A
LITTLE ROCK AR
72212-4191
US

IV. Provider business mailing address

3805 W 28TH AVE
PINE BLUFF AR
71603-4774
US

V. Phone/Fax

Practice location:
  • Phone: 501-830-2020
  • Fax: 501-830-2021
Mailing address:
  • Phone: 870-536-4100
  • Fax: 870-534-3982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberE-15161
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD37037
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: