Individual
DR. BRANDON S CHISM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3211 N NORTHHILLS BLVD, SUITE 110, FAYETTEVILLE, AR 72703-4007
(479) 571-4338
(479) 571-4015
Mailing address
3211 N NORTHHILLS BLVD, SUITE 110, FAYETTEVILLE, AR 72703-4007
(479) 571-4338
(479) 571-4015
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
35183
AZ
207RC0000X
Cardiovascular Disease Physician
Primary
E-4651
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
090498
—
AZ
01
—
E-4651
STATE MEDICAL LICENSE
AR
01
—
P00381947
RAILROAD MEDICARE
AZ
Enumeration date
04/26/2006
Last updated
06/28/2012
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