Organization
JEFFERSON ANESTHESIOLOGY ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FERDINAND K SAMUEL M.D. (ADMINISTRATOR/PARTNER)
(870) 535-7457
Entity
Organization
Contact information
Practice address
1801 W 40TH AVE, SUITE 2B, PINE BLUFF, AR 71603-6900
(870) 535-7457
Mailing address
PO BOX 1272, PINE BLUFF, AR 71613-1272
(870) 535-7457
(870) 535-2522
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103014002
—
AR
01
—
57360
BCBS
AR
01
—
CP0148
RRMCR/PGBA
—
Enumeration date
09/30/2005
Last updated
04/13/2009
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