Individual
AMITA HEASER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
6801 ROGERS AVE, FORT SMITH, AR 72903-4067
(479) 274-4100
(479) 274-4199
Mailing address
PO BOX 17025, FORT SMITH, AR 72917-7025
(479) 274-2000
(479) 274-2194
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036-127885
IL
207R00000X
Internal Medicine Physician
125054221
IL
207R00000X
Internal Medicine Physician
E9240
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036127885
—
IL
01
—
04515143
BCBS#
IL
01
—
5BA25
ARKANSAS BLUECROSS BLUE SHIELD
AR
Enumeration date
08/06/2008
Last updated
08/28/2015
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