# PRIMARY CARE 360

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124678586
- **Authorized official:** DR. KHALID RAYAZ MD (OWNER)
- **Authorized official phone:** (501) 833-4001

## Contact information

- **Practice address:** 100 SHADOW OAKS DR, SHERWOOD, AR 72120-6046
- **Practice address phone:** (501) 486-4045
- **Mailing address:** 100 SHADOW OAKS DR, SHERWOOD, AR 72120-6046
- **Mailing address phone:** (501) 486-4045
- **Mailing address fax:** (888) 213-5007

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/18/2019
- **Last updated:** 10/21/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | E-4732 | STATE LICENSE | AR |