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Individual

ASHISH MATHUR

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
643 E 3RD ST, GENTRY, AR 72734-8258
(479) 736-2213
(479) 736-2105
Mailing address
643 E 3RD ST, PO BOX 9, GENTRY, AR 72734-8258
(479) 736-2213
(479) 736-2105

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
24117
OK
207Q00000X
Family Medicine Physician
Primary
E5401
AR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
165673001
AR
05
200096500B
OK
01
5N971
BCBS OF ARKANSAS
AR
01
P00620016
MEDICARE RAILROAD ARKANSAS
AR
Enumeration date
10/12/2006
Last updated
08/11/2011
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