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 |
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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. Olabode Olaosebikan Desalu, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 2601 Gene George Blvd, Springdale, AR 72762 Phone: 479-725-6977 Fax: 479-725-6577 | |
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 | |
Sarah Jeffreys, Pediatrics Medicare: Medicare Enrolled Practice Location: 2601 Gene George Blvd, Springdale, AR 72762 Phone: 479-725-6801 Fax: 479-725-6577 | |
Dr. Hilary H Mcclafferty, MD Pediatrics Medicare: Accepting Medicare Assignments Practice Location: 2601 Gene George Blvd, Springdale, AR 72762 Phone: 479-725-6801 Fax: 479-725-6577 |