Provider Demographics
NPI:1205037611
Name:DECLERK, GEORGE RYAN (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:RYAN
Last Name:DECLERK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2603 W PLEASANT GROVE RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-5804
Mailing Address - Country:US
Mailing Address - Phone:479-636-4138
Mailing Address - Fax:479-636-4140
Practice Address - Street 1:2603 W PLEASANT GROVE RD
Practice Address - Street 2:SUITE 109
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-5804
Practice Address - Country:US
Practice Address - Phone:479-636-4138
Practice Address - Fax:479-636-4140
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2020-09-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ARE5450207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine