Provider Demographics
NPI:1295752368
Name:GEHRKI, GARY P (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:P
Last Name:GEHRKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GARY
Other - Middle Name:P
Other - Last Name:GEHRKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2850 TWIN RIVERS DR STE 101B
Mailing Address - Street 2:
Mailing Address - City:ARKADELPHIA
Mailing Address - State:AR
Mailing Address - Zip Code:71923-4226
Mailing Address - Country:US
Mailing Address - Phone:870-246-8034
Mailing Address - Fax:870-246-3536
Practice Address - Street 1:2850 TWIN RIVERS DR STE 101B
Practice Address - Street 2:
Practice Address - City:ARKADELPHIA
Practice Address - State:AR
Practice Address - Zip Code:71923-4226
Practice Address - Country:US
Practice Address - Phone:870-246-8034
Practice Address - Fax:870-246-3536
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC5914207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR101441001Medicaid
AR51867Medicare ID - Type Unspecified
AR101441001Medicaid