Provider Demographics
NPI:1891816153
Name:MCGARRY, PATRICIA G (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:G
Last Name:MCGARRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6640 CONGO RD.
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72019-6913
Mailing Address - Country:US
Mailing Address - Phone:501-794-4110
Mailing Address - Fax:501-316-9360
Practice Address - Street 1:6640 CONGO RD.
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72019-6913
Practice Address - Country:US
Practice Address - Phone:501-794-4110
Practice Address - Fax:501-316-9360
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE0689207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR128691001Medicaid
ARG14222Medicare UPIN
AR5J875Medicare PIN
ARG14222Medicare UPIN