Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | E2962 | AR |
NPI | 1033189857 |
---|---|
Provider Name | Dr. Reza Shahim |
First Address | North Little Rock, AR 72118-5312 |
Second Address | North Little Rock, AR 72118-5312 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2006 |
Last Update Date | 13/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
142824001 | (05) | AR |
5394650001 | MEDICARE DME (01) | AR |
G86653 | (02) | AR |