Provider Demographics
NPI:1083644959
Name:VILLINES, GARY WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:WAYNE
Last Name:VILLINES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 960454
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73196-0454
Mailing Address - Country:US
Mailing Address - Phone:405-844-1830
Mailing Address - Fax:405-341-9217
Practice Address - Street 1:24 NORRIS ST
Practice Address - Street 2:EMER DEPT
Practice Address - City:EUREKA SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72632-3541
Practice Address - Country:US
Practice Address - Phone:479-253-7400
Practice Address - Fax:479-253-7400
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2024-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC4980207PE0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR102792001Medicaid
ARP01150508OtherRRMCARE
ARP01150508OtherRRMCARE
AR930120362Medicare PIN
AR257677YH95Medicare PIN
AR554236686Medicare PIN
ARAV6553312OtherDEA
AR102792001Medicaid