Individual
DR. JONATHAN T GHORMLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
550 CLUB LANE, SUITE 1, CONWAY, AR 72034-3681
(501) 329-1510
(501) 329-5697
Mailing address
550 CLUB LANE, SUITE 1, CONWAY, AR 72034-3681
(501) 329-1510
(501) 329-5697
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
R3946
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
115941001
—
AR
01
—
12591000000
QUALCHOICE
AR
05
—
130436716
—
AR
01
—
200017919
RR MEDICARE
AR
01
—
52911
BCBS
AR
Enumeration date
08/19/2005
Last updated
12/31/2007
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