Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | E0503 | AR |
NPI | 1033110556 |
---|---|
Provider Name | Samuel W Vallery |
First Address | El Dorado, AR 71730-4469 |
Second Address | Hot Springs, AR 71901-8038 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2005 |
Last Update Date | 09/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
16278000001 | QUALCHOICE (01) | |
166792002 | (05) | AR |
5J718 | BCBS (01) | |
F75918 | (02) | AR |
P00470953 | RAILROAD MEDICARE PTAN (01) | AR |