Provider Demographics
NPI:1114968070
Name:GREAR, TIM W (MD)
Entity Type:Individual
Prefix:
First Name:TIM
Middle Name:W
Last Name:GREAR
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 1247
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72702-1247
Mailing Address - Country:US
Mailing Address - Phone:479-442-7322
Mailing Address - Fax:479-442-7379
Practice Address - Street 1:3380 N FUTRALL DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4057
Practice Address - Country:US
Practice Address - Phone:479-442-7322
Practice Address - Fax:479-442-7379
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARR-4002208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR115781001Medicaid
AR52987OtherAR BC/BS
AR52987Medicare ID - Type Unspecified
AR115781001Medicaid
AR52987OtherAR BC/BS