Provider Demographics
NPI:1407821374
Name:PADDOCK, GEORGE O (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:O
Last Name:PADDOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 CRESTVIEW PLZ
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72076-4341
Mailing Address - Country:US
Mailing Address - Phone:501-985-0616
Mailing Address - Fax:501-985-0715
Practice Address - Street 1:21 CRESTVIEW PLZ
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076-4341
Practice Address - Country:US
Practice Address - Phone:501-985-0616
Practice Address - Fax:501-985-0715
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARC4362207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR109545001Medicaid
AR53583Medicare ID - Type Unspecified
AR109545001Medicaid