Provider Demographics
NPI:1558552075
Name:WM GARY DARWIN M.D., PA
Entity Type:Organization
Organization Name:WM GARY DARWIN M.D., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:GARY
Authorized Official - Last Name:DARWIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-562-1463
Mailing Address - Street 1:6924 GEYER SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72209-2728
Mailing Address - Country:US
Mailing Address - Phone:501-562-1463
Mailing Address - Fax:501-562-2702
Practice Address - Street 1:6924 GEYER SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72209-2728
Practice Address - Country:US
Practice Address - Phone:501-562-1463
Practice Address - Fax:501-562-2702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
57663Medicare UPIN