MEDICARE: GENTRY PARKER DAMRON DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207Q00000X	Family Medicine Physician	E-17789	AR

General Provider Information

NPI Number	:	1063152338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GENTRY PARKER DAMRON DO

Provider Business Mailing Address
First Line	:	PO BOX 776084
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-6084
Country	:	US
Telephone Number	:	479-877-7800
Fax Number	:

Provider Business Practice Location Address
First Line	:	4502 S DIXIELAND RD
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72758-3067
Country	:	US
Telephone Number	:	479-877-7800
Fax Number	:	479-877-7801

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2022
Last Update Date	:	08/06/2025

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Directions to “ GENTRY PARKER DAMRON DO” Practice Location

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