Individual
MASHHUD M MIRZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1120 STATE HIGHWAY 77, STE 1, MARION, AR 72364-9027
(870) 733-1177
(870) 702-6128
Mailing address
PO BOX 55, MARION, AR 72364-0055
(870) 733-1177
(870) 702-6128
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
E1005
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110217316
RAILROAD MEDICARE
—
05
—
136518001
—
AR
01
—
3154566
BLUE CROSS
TN
01
—
5K483
BLUE CROSS
AR
Enumeration date
06/18/2006
Last updated
03/02/2010
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