Provider Demographics
NPI:1881650554
Name:GRAMMER, WILLIAM CODY (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CODY
Last Name:GRAMMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:W.
Other - Middle Name:CODY
Other - Last Name:GRAMMER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1000 S 52ND ST
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8610
Mailing Address - Country:US
Mailing Address - Phone:479-271-9607
Mailing Address - Fax:479-271-2133
Practice Address - Street 1:1000 S 52ND ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8610
Practice Address - Country:US
Practice Address - Phone:479-271-9607
Practice Address - Fax:479-271-2133
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE3467207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5M951Medicare ID - Type Unspecified
ARI08288Medicare UPIN
AR679104OtherHEALTHLINK
AR154818001Medicaid