MEDICARE: DR. GARY V FELKER M.D.

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	174400000X	Specialist	C4345	AR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CQ2384	OTHER	AR	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51639	OTHER	AR	BCBS

General Provider Information

NPI Number	:	1619949500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY V FELKER M.D.

Provider Business Mailing Address
First Line	:	3000 ROGERS AVE
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72901-4232
Country	:	US
Telephone Number	:	479-782-8892
Fax Number	:	479-782-8840

Provider Business Practice Location Address
First Line	:	3000 ROGERS AVE
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72901-4232
Country	:	US
Telephone Number	:	479-782-8892
Fax Number	:	479-782-8840

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

Provider Enumeration Date	:	02/03/2006
Last Update Date	:	02/20/2008

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