Provider Demographics
NPI:1619929346
Name:WAHMAN, GERALD EUGENE (MD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:EUGENE
Last Name:WAHMAN
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 1:5500 ELLSWORTH RD
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-3222
Mailing Address - Country:US
Mailing Address - Phone:479-242-2411
Mailing Address - Fax:479-242-2412
Practice Address - Street 1:5500 ELLSWORTH RD.
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-3222
Practice Address - Country:US
Practice Address - Phone:479-242-2411
Practice Address - Fax:479-242-2412
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR1930208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR105683001Medicaid
AR55442OtherBLUE CROSS
AR55442OtherBLUE CROSS