Individual
FERDINAND K SAMUEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1801 W 40TH AVE, STE 2B, PINE BLUFF, AR 71603-6957
(870) 535-7457
(870) 535-2522
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
R2879
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050019321
RAILROAD MEDICARE/PGBA
—
05
—
103013001
—
AR
01
—
54658
BCBS
AR
01
—
AR6003787
TRICARE/HUMANA
—
Enumeration date
06/16/2005
Last updated
06/24/2008
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