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General NPI Number Information
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NPI Number | 1366484479
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Entity Type | Individual
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Provider Name | JOHN N GILLESPIE MD
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Gender | Male
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Dates
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Enumeration Date | 06/12/2006
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Last Update Date | 06/12/2019
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Provider Practice Location Address
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Address Line | 2711 E PARKWAY DR
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City | RUSSELLVILLE
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State | AR
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Zip | 72802-2006
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Country | US
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Telephone | 479-968-7302
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Fax |
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Provider Business Mailing Address
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Address Line | 1235 CAMBRIDGE RD
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City | BENTON
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State | AR
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Zip | 72019-2378
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Country | US
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Telephone | 501-765-8813
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | E2388
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License Number State | AR
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