Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | E4731 | AR |
NPI | 1013131275 |
---|---|
Provider Name | Dr. Ali I Raja |
First Address | Little Rock, AR 72205-3326 |
Second Address | Little Rock, AR 72205-3326 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2007 |
Last Update Date | 14/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
172805001 | (05) | AR |
P00622530 | RAILROAD MEDICARE (01) | AR |
P00622542 | RAILROAD MEDICARE (01) | AR |