Provider Demographics
NPI:1306069661
Name:ARKANSAS GYN ONCOLOGY
Entity type:Organization
Organization Name:ARKANSAS GYN ONCOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:CURTIS
Authorized Official - Last Name:BANDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-221-3088
Mailing Address - Street 1:9601 LILE DR
Mailing Address - Street 2:SUITE 850
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6321
Mailing Address - Country:US
Mailing Address - Phone:501-221-3088
Mailing Address - Fax:501-221-0072
Practice Address - Street 1:9601 LILE DR
Practice Address - Street 2:SUITE 850
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6321
Practice Address - Country:US
Practice Address - Phone:501-221-3088
Practice Address - Fax:501-221-0072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR02110034500OtherQUALCHOICE
AR5C905OtherBCBS
AR771041202OtherBREAST CARE MEDICAID
AR150515002Medicaid
ARDA3533OtherRR MEDICARE
AR5C905OtherBCBS
ARC82694Medicare UPIN