Provider Demographics
NPI:1538154570
Name:BEVILL, GARY LLOYD (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:LLOYD
Last Name:BEVILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:600 S TIMBERLANE DR
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-6990
Mailing Address - Country:US
Mailing Address - Phone:870-862-2400
Mailing Address - Fax:870-862-1891
Practice Address - Street 1:600 S TIMBERLANE DR
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-6990
Practice Address - Country:US
Practice Address - Phone:870-862-2400
Practice Address - Fax:870-862-1891
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2014-02-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ARC6179207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR106190001Medicaid
AR106190001Medicaid
ARB89972Medicare UPIN