Provider Demographics
NPI:1700842218
Name:OVER, DARRELL R (MD)
Entity Type:Individual
Prefix:
First Name:DARRELL
Middle Name:R
Last Name:OVER
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 1:4010 S MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-7000
Mailing Address - Country:US
Mailing Address - Phone:870-541-6008
Mailing Address - Fax:870-541-3198
Practice Address - Street 1:4010 S MULBERRY ST
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-7000
Practice Address - Country:US
Practice Address - Phone:870-541-6008
Practice Address - Fax:870-541-3198
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-1462207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5K560OtherMEDICARE
AR18887000002OtherQUAL CHOICE
ARG53750OtherUPIN
AR132760001Medicaid