Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | E2130 | AR |
NPI | 1053423350 |
---|---|
Provider Name | Safwan H Sakr |
First Address | Little Rock, AR 72205-6217 |
Second Address | Little Rock, AR 72205-6217 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 17/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
136502001 | (05) | AR |
743378 | MEDICARE ID# FOR CHI ST. VINCENT LITTLE ROCK DIAGNOSTIC CLINIC (01) | AR |
G57709 | (02) | AR |