Individual
MOHAMMAD IDRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
14 GOTHIC RIDGE RD, VAN BUREN, AR 72956-6565
(479) 471-0011
(479) 471-1960
Mailing address
PO BOX 405981, ATLANTA, GA 30384-5981
(479) 709-7399
(479) 709-7053
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
E7605
AR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/15/2009
Last updated
09/13/2012
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