Individual
GORDON R PARHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3215 N NORTHHILLS BLVD, FAYETTEVILLE, AR 72703-4424
(479) 463-7102
(479) 463-7864
Mailing address
PO BOX 550, LOWELL, AR 72745-0550
(479) 463-7775
(479) 463-7187
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
C5999
AR
208M00000X
Hospitalist Physician
Primary
C-5999
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100074270A
—
OK
05
—
105750001
—
AR
Enumeration date
10/06/2005
Last updated
01/09/2018
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