Provider Demographics
NPI:1558485656
Name:GUNTHARP, GEORGE RANDALL (DO)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:RANDALL
Last Name:GUNTHARP
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 BETTY DR
Mailing Address - Street 2:
Mailing Address - City:POCAHONTAS
Mailing Address - State:AR
Mailing Address - Zip Code:72455-3602
Mailing Address - Country:US
Mailing Address - Phone:870-892-9949
Mailing Address - Fax:870-892-0208
Practice Address - Street 1:141 BETTY DR
Practice Address - Street 2:
Practice Address - City:POCAHONTAS
Practice Address - State:AR
Practice Address - Zip Code:72455-3602
Practice Address - Country:US
Practice Address - Phone:870-892-9949
Practice Address - Fax:870-892-0208
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARN8208207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR123282003Medicaid
AR123282003Medicaid
AR55926Medicare ID - Type Unspecified