Individual
TABASUM IMRAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1301 S E ST, FORT SMITH, AR 72901-4716
(479) 785-2431
(479) 494-7787
Mailing address
612 S 12TH ST, FORT SMITH, AR 72901-4702
(479) 785-2431
(479) 494-7787
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
E6776
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
187256001
—
AR
05
—
200232010A
—
OK
Enumeration date
06/24/2008
Last updated
04/14/2017
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