Organization
GASTROENTEROLOGY ASSOCIATES OF SOUTHEAST ARKANSAS, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. O T GORDON JR. M.D. (PRESIDENT)
(870) 534-3344
Entity
Organization
Contact information
Practice address
1609 W 40TH AVE, SUITE 312, PINE BLUFF, AR 71603-6329
(870) 534-3344
(870) 534-3517
Mailing address
1609 W 40TH AVE, SUITE 312, PINE BLUFF, AR 71603-6329
(870) 534-3344
(870) 534-3517
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
C5353
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5C989
BLUE CROSS BLUE SHIELD
AR
01
—
DB2069
RAIL ROAD MEDICARE
AR
Enumeration date
06/04/2006
Last updated
03/24/2008
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