Provider Demographics
NPI:1811968092
Name:CRANFORD, RUSSELL L (MD)
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:L
Last Name:CRANFORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11001 EXECUTIVE CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4393
Mailing Address - Country:US
Mailing Address - Phone:501-812-7800
Mailing Address - Fax:501-812-7777
Practice Address - Street 1:11719 HINSON ROAD
Practice Address - Street 2:SUITE 110
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212-3402
Practice Address - Country:US
Practice Address - Phone:501-224-2875
Practice Address - Fax:501-221-9251
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC 5042207Q00000X
ARC-5042207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR51204Medicare ID - Type Unspecified
ARC68092Medicare UPIN