Organization
DOC NETWORK, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIAN W. GRANTHAM M.D. (PRESIDENT)
(800) 568-1441
Entity
Organization
Contact information
Practice address
3601 NW CREEKSTONE BLVD, BENTONVILLE, AR 72712-8672
(800) 568-1441
(866) 614-8297
Mailing address
3601 NW CREEKSTONE BLVD, BENTONVILLE, AR 72712-8672
(800) 568-1441
(866) 614-8297
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
E5998
AR
207Q00000X
Family Medicine Physician
E5998
AR
208D00000X
General Practice Physician
Primary
E5998
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
178393001
—
AR
01
—
5H426
BLUE CROSS BLUE SHIELD
AR
Enumeration date
09/12/2011
Last updated
07/09/2024
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