1346283173 NPI number — DANNA F GREAR MD

Table of content: DANNA F GREAR MD (NPI 1346283173)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346283173 NPI number — DANNA F GREAR MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GREAR
Provider First Name:
DANNA
Provider Middle Name:
F
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346283173
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/19/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1523
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72702-1523
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-571-6038
Provider Business Mailing Address Fax Number:
479-582-0222

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
55 W SUNBRIDGE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-442-6266
Provider Business Practice Location Address Fax Number:
479-521-3877
Provider Enumeration Date:
06/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  R-3977 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 116447001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00190608 . This is a "RR MCR" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 100180240B , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 53224 . This is a "AR BC/BS" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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