Provider Demographics
NPI:1699757161
Name:GINGER, JOHN DARRELL (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:DARRELL
Last Name:GINGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8220
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-0004
Mailing Address - Country:US
Mailing Address - Phone:479-521-2525
Mailing Address - Fax:479-521-5725
Practice Address - Street 1:1708 E JOYCE BLVD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5252
Practice Address - Country:US
Practice Address - Phone:479-521-2525
Practice Address - Fax:479-521-5725
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-4069174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARB90216Medicare UPIN
AR51888Medicare ID - Type Unspecified