Provider Demographics
NPI:1134130479
Name:GL CRANFILL MD PA
Entity Type:Organization
Organization Name:GL CRANFILL MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GENERAL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CRANFILL
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:870-802-3548
Mailing Address - Street 1:615 E MATTHEWS
Mailing Address - Street 2:STE C
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401
Mailing Address - Country:US
Mailing Address - Phone:870-802-3548
Mailing Address - Fax:870-802-2568
Practice Address - Street 1:615 E MATTHEWS
Practice Address - Street 2:STE C
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401
Practice Address - Country:US
Practice Address - Phone:870-802-3548
Practice Address - Fax:870-802-2568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR4071207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR53629OtherARKANSAS BLUE CROSS BLUE SHIELD
AR117454001Medicaid
AR5G011Medicare PIN
AR53629OtherARKANSAS BLUE CROSS BLUE SHIELD