Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0000X | Hematologist | E-3306 | AR |
Y | 207RH0003X | Hematology & Oncology | E-3306 | AR |
N | 207RX0202X | Medical Oncology | E-3306 | AR |
NPI | 1477643955 |
---|---|
Provider Name | Issam Makhoul |
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 | 13/10/2006 |
Last Update Date | 20/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02120013100 | QUALCHOICE (01) | AR |
148205001 | (05) | AR |
5M338 | BCBS (01) | AR |
830008472 | RAILROAD MEDICARE1 (01) | AR |
H68812 | (02) |