Provider Demographics
NPI:1871084301
Name:SIDDONS, UPTON GARDNER SR (MD)
Entity type:Individual
Prefix:DR
First Name:UPTON
Middle Name:GARDNER
Last Name:SIDDONS
Suffix:SR
Gender:M
Credentials:MD
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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:479-996-5585
Mailing Address - Fax:479-996-5386
Practice Address - Street 1:1480 W CENTER ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:AR
Practice Address - Zip Code:72936-3449
Practice Address - Country:US
Practice Address - Phone:479-996-5585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-21
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE-12892207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine