Individual
CHARLES MOUSSALLEM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
1500 DODSON AVE, SUITE 280, FORT SMITH, AR 72901-5182
(479) 709-7480
(479) 709-7479
Mailing address
1500 DODSON AVE, # 280, FORT SMITH, AR 72901-5182
(479) 709-7399
(479) 709-7053
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
E-8013
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200504590A
—
OK
Enumeration date
11/02/2010
Last updated
11/27/2017
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