Provider Demographics
NPI:1386608636
Name:GYNECOLOGIC ONCOLOGY OF ARKANSAS
Entity type:Organization
Organization Name:GYNECOLOGIC ONCOLOGY OF ARKANSAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:SAYRE
Authorized Official - Last Name:BARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-228-7779
Mailing Address - Street 1:9501 LILE DR
Mailing Address - Street 2:STE 777
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6232
Mailing Address - Country:US
Mailing Address - Phone:501-228-7779
Mailing Address - Fax:501-228-7877
Practice Address - Street 1:9501 LILE DR
Practice Address - Street 2:STE 777
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6232
Practice Address - Country:US
Practice Address - Phone:501-228-7779
Practice Address - Fax:501-228-7877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5B198Medicare ID - Type Unspecified