Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | E-1880 | AR |
NPI | 1063494953 |
---|---|
Provider Name | Balagopalan Nair |
First Address | Little Rock, AR 72215-5050 |
Second Address | Little Rock, AR 72205-6523 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2005 |
Last Update Date | 05/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
134679001 | (05) | AR |
F84409 | (02) | AR |