Individual
DR. EDWARD A GRESHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
909 UNITY RD, CROSSETT, AR 71635-9444
(870) 364-9111
(870) 364-5581
Mailing address
PO BOX 340, CROSSETT, AR 71635-0340
(870) 364-9111
(870) 364-5581
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
G5569
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104845001
—
AR
01
—
15181
QUALCHOICE
AR
Enumeration date
01/20/2006
Last updated
02/08/2010
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