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1245227057

NPI Code Detail

MEDICARE: GORDON R PARHAM MD

MEDICARE: GORDON R PARHAM MD

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	207Q00000X	Family Medicine Physician	C5999	AR
2	208M00000X	Hospitalist Physician	C-5999	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245227057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GORDON R PARHAM MD

Provider Business Mailing Address
First Line	:	PO BOX 550
Second Line	:
City	:	LOWELL
State	:	AR
Zip	:	72745-0550
Country	:	US
Telephone Number	:	479-463-7775
Fax Number	:	479-463-7187

Provider Business Practice Location Address
First Line	:	3215 N NORTHHILLS BLVD
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72703-4424
Country	:	US
Telephone Number	:	479-463-7102
Fax Number	:	479-463-7864

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

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	01/09/2018

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Directions to “ GORDON R PARHAM MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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