| Dr Anil V Gajare, MD | |
|
2601 Gene George Blvd, Springdale, AR 72762-0845 | |
| (479) 725-6801 | |
| (479) 725-6577 |
| Full Name | Dr Anil V Gajare |
|---|---|
| Gender | Male |
| Speciality | Pediatrics |
| Location | 2601 Gene George Blvd, Springdale, Arkansas |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518245828 | NPI | - | NPPES |
| 224912001 | Medicaid | AR | |
| Q1150 | Other | TX | TEXAS MEDICAL BOARD |
| 018864 | Other | ME | ME LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208000000X | Pediatrics | Q1150 (Texas) | Secondary |
| 208000000X | Pediatrics | 018864 (Maine) | Secondary |
| 208000000X | Pediatrics | E-11028 (Arkansas) | Primary |
| Entity Name | Banner Physician Super Specialists Arizona Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1841573870 PECOS PAC ID: 7911173794 Enrollment ID: O20111228000353 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Anil V Gajare, MD 1 Childrens Way # 844, Little Rock, AR 72202-3500 Ph: (501) 364-2090 | Dr Anil V Gajare, MD 2601 Gene George Blvd, Springdale, AR 72762-0845 Ph: (479) 725-6801 |
Jeffrey Dale Grills, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 2601 Gene George Blvd, Springdale, AR 72762 Phone: 479-725-6977 Fax: 479-725-6577 | |
Dr. Meredith Anne Denton, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 3057 Springdale Ave, Springdale, AR 72762 Phone: 479-756-1699 Fax: 479-756-1693 | |
Dr. Bryce Alston Vance, D.O. Pediatrics Medicare: Medicare Enrolled Practice Location: 2601 Gene George Blvd, Springdale, AR 72762 Phone: 479-309-5391 Fax: 479-725-6582 | |
Casie Marie James, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 2601 Gene George Blvd, Springdale, AR 72762 Phone: 479-725-6866 Fax: 479-725-6868 | |
Dr. Sarah Morris Weston, M.D. Pediatrics Medicare: Accepting Medicare Assignments Practice Location: 2601 Gene George Blvd, Springdale, AR 72762 Phone: 479-725-6977 Fax: 479-725-6577 | |
Andrew Arthur Martin, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 2601 Gene George Blvd, Springdale, AR 72762 Phone: 794-725-6801 Fax: 479-725-6577 | |
Dr. Matthew W Deel, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 2575 Gene George Blvd Ste 100, Springdale, AR 72762 Phone: 479-750-0125 Fax: 479-750-0323 |