Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | E4008 | AR |
N | 207QG0300X | Family Doctor - Geriatric Medicine | E-4008 | AR |
NPI | 1265497242 |
---|---|
Provider Name | Sanjay R Dass |
First Address | Little Rock, AR 72205-5405 |
Second Address | Little Rock, AR 72205-5405 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2006 |
Last Update Date | 20/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
157860001 | (05) | AR |
I34327 | (02) | AR |
I34327 | UPIN (01) | AR |
P00385214 | RAILROAD MEDICARE (01) | AR |
P01266783 | RAILROAD MCARE (01) | AR |