Individual
GIDEON S MECUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3215 N. NORTH HILL DRIVE, FAYETTEVILLE, AR 72703-4424
(479) 463-7102
(479) 463-7864
Mailing address
2730 E MOCKERNUT XING, FAYETTEVILLE, AR 72703-4938
(479) 236-0470
Taxonomy
Speciality
Code
Description
License number
State
207PP0204X
Pediatric Emergency Medicine (Emergency Medicine) Physician
E-6020
AR
208000000X
Pediatrics Physician
Primary
E-6020
AR
208M00000X
Hospitalist Physician
E-6020
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
177619001
—
AR
Enumeration date
04/25/2007
Last updated
02/18/2019
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