Individual
DR. RUSSELL S GORNICHEC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
501 W GRAND AVE, HOT SPRINGS, AR 71901
(501) 781-0772
(501) 781-4000
Mailing address
501 W GRAND AVE, HOT SPRINGS, AR 71901-3931
(501) 781-0772
(501) 781-4000
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
01077212A
IN
208600000X
Surgery Physician
21488
OK
208600000X
Surgery Physician
E7873
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100827130B
—
OK
01
—
1021531
ANTHEM
IN
05
—
201233001
—
AR
01
—
50113964
KY PASSPORT
KY
01
—
7008146
AETNA
IN
01
—
P00013588
RAILROAD MEDICARE
OK
Enumeration date
02/01/2006
Last updated
01/06/2021
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