MEDICARE: SAMUEL DAVID REGISTER III MD

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LP2900X	Pain Medicine (Anesthesiology) Physician	E7122	AR
2	2083P0011X	Undersea and Hyperbaric Medicine (Preventive Medicine) Physician	E7122	AR

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	5I097	OTHER	AR	BCBS

NPI Number	:	1003853862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL DAVID REGISTER III MD

Provider Business Mailing Address
First Line	:	3500 SPRINGHILL DR STE 200A
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72117-2948
Country	:	US
Telephone Number	:	501-945-0392
Fax Number	:	501-945-0394

Provider Business Practice Location Address
First Line	:	3500 SPRINGHILL DR STE 200A
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72117-2948
Country	:	US
Telephone Number	:	501-202-3638
Fax Number	:	501-202-3639

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	11/13/2019

3500 SPRINGHILL DR
N LITTLE ROCK, AR
72117-2948

Practice Phone: 501-945-4710
Practice Fax: 501-955-9027

3500 SPRINGHILL DR STE 200A
NORTH LITTLE ROCK, AR
72117-2948