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General NPI Number Information
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NPI Number | 1437121860
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Entity Type | Individual
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Provider Name | RUSSELL S GORNICHEC MD
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Gender | Male
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Dates
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Enumeration Date | 02/01/2006
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Last Update Date | 01/06/2021
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Provider Practice Location Address
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Address Line | 501 W GRAND AVE
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City | HOT SPRINGS
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State | AR
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Zip | 71901
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Country | US
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Telephone | 501-781-0772
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Fax | 501-781-4000
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Provider Business Mailing Address
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Address Line | 501 W GRAND AVE
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City | HOT SPRINGS
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State | AR
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Zip | 71901-3931
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Country | US
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Telephone | 501-781-0772
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Fax | 501-781-4000
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | E7873
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 21488
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 01077212A
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License Number State | IN
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