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Individual

EDWARD LARRY GILLS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
880 W MAIN ST, BOONEVILLE, AR 72927-3443
(479) 675-2800
(479) 452-0275
Mailing address
PO BOX 776084, CHICAGO, IL 60677-6084
(479) 675-2800
(314) 364-6321

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
E1830
AR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100166610C
OK
05
135306001
AR
Enumeration date
07/31/2006
Last updated
04/29/2025
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