Provider Demographics
NPI:1518249929
Name:DOC NETWORK, INC.
Entity Type:Organization
Organization Name:DOC NETWORK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:GRANTHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-568-1441
Mailing Address - Street 1:11705 EAST CREEK LANE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:AR
Mailing Address - Zip Code:72730
Mailing Address - Country:US
Mailing Address - Phone:800-568-1441
Mailing Address - Fax:866-614-8297
Practice Address - Street 1:11705 E CREEK LN
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:AR
Practice Address - Zip Code:72730-9564
Practice Address - Country:US
Practice Address - Phone:800-568-1441
Practice Address - Fax:866-614-8297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-12
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE5998207PE0004X, 207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR178393001Medicaid
AR5H426OtherBLUE CROSS BLUE SHIELD
AR5H426OtherBLUE CROSS BLUE SHIELD