Individual
DR. SHAMSUL ALAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2618 SE J ST, SUITE # 2 & 4, BENTONVILLE, AR 72712-3767
(479) 271-9393
(479) 271-0141
Mailing address
11149 COBBLESTONE, BENTONVILLE, AR 72712-7379
(479) 271-9393
(479) 271-0141
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
E4954
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
168252001
—
AR
05
—
200277530A
—
OK
01
—
27959
OKLAHOMA STATE MEDICAL LICENSE
OK
05
—
A68252001
—
AR
Enumeration date
05/26/2006
Last updated
09/28/2015
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