Provider Demographics
NPI:1063152338
Name:DAMRON, GENTRY PARKER (DO)
Entity type:Individual
Prefix:
First Name:GENTRY
Middle Name:PARKER
Last Name:DAMRON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 776084
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6084
Mailing Address - Country:US
Mailing Address - Phone:479-877-7800
Mailing Address - Fax:
Practice Address - Street 1:4502 S DIXIELAND RD
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-3067
Practice Address - Country:US
Practice Address - Phone:479-877-7800
Practice Address - Fax:479-877-7801
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-01
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ARE-17789207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program