Provider Demographics
NPI:1154300648
Name:BRUNSON, GAYLON LYN (MD)
Entity Type:Individual
Prefix:DR
First Name:GAYLON
Middle Name:LYN
Last Name:BRUNSON
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 1:501 N UNIVERSITY AVE
Mailing Address - Street 2:SUITE 100-A
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-2900
Mailing Address - Country:US
Mailing Address - Phone:501-663-3990
Mailing Address - Fax:501-663-3669
Practice Address - Street 1:501 N UNIVERSITY AVE
Practice Address - Street 2:SUITE 100-A
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-2900
Practice Address - Country:US
Practice Address - Phone:501-663-3990
Practice Address - Fax:501-663-3669
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC5982207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR50722OtherBLUE CROSS AND BLUE SHIEL
AR50722OtherHEALTH ADVANTAGE
AR7420010OtherUNITED HEALTH CARE
AR1256000000OtherQUALCHOICE
C67903Medicare UPIN
AR50722OtherHEALTH ADVANTAGE