# GUSTAVUS FAMILY CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MARDUK INC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1467692103
- **Legal business name:** MARDUK INC
- **Authorized official:** DR. JOHN L GUSTAVUS MD (OWNER)
- **Authorized official phone:** (501) 833-0177

## Contact information

- **Practice address:** 7418 N HILLS BLVD, NORTH LITTLE ROCK, AR 72116-4525
- **Practice address phone:** (501) 833-0177
- **Practice address fax:** (501) 833-0223
- **Mailing address:** 7418 N HILLS BLVD, NORTH LITTLE ROCK, AR 72116-4525
- **Mailing address phone:** (501) 833-0177
- **Mailing address fax:** (501) 833-0223

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/20/2009
- **Last updated:** 03/13/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 52054C761 | BCBS OF AR | AR |