1144399718 NPI number — DR. AMR G. EL-SHAFEI MD

Table of content: DR. AMR G. EL-SHAFEI MD (NPI 1144399718)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144399718 NPI number — DR. AMR G. EL-SHAFEI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EL-SHAFEI
Provider First Name:
AMR
Provider Middle Name:
G.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144399718
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2708 RIFE MEDICAL LANE
Provider Second Line Business Mailing Address:
SUITE 220
Provider Business Mailing Address City Name:
ROGERS
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72758-1452
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-338-4400
Provider Business Mailing Address Fax Number:
479-338-4445

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2708 RIFE MEDICAL LANE
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
ROGERS
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72758-1452
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-338-4400
Provider Business Practice Location Address Fax Number:
479-338-4445
Provider Enumeration Date:
11/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  E5639 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 171853001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com