Provider Demographics
NPI:1235102724
Name:ALLARD, MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:ALLARD
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 1:601 W MAPLE AVE
Mailing Address - Street 2:STE 401
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-5383
Mailing Address - Country:US
Mailing Address - Phone:479-757-5052
Mailing Address - Fax:479-757-5059
Practice Address - Street 1:601 W MAPLE AVE STE 401
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-5383
Practice Address - Country:US
Practice Address - Phone:479-757-5052
Practice Address - Fax:479-757-5059
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC8102207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR123372001Medicaid
F20491Medicare UPIN
AR123372001Medicaid
AR55306Medicare PIN
55306Medicare PIN