Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | E-0109 | AR |
NPI | 1043300528 |
---|---|
Provider Name | Ali Krisht |
First Address | Sherwood, AR 72120-6068 |
Second Address | Sherwood, AR 72120-6068 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 27/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
125669001 | (05) | AR |
140002920 | RAILROAD MEDICARE (01) | AR |
140004608 | RAILROAD MEDICARE (01) | AR |
F82840 | (02) |