Healthcare Provider Details

I. General information

NPI: 1770657827
Provider Name (Legal Business Name): SIAMAK SHAHRIARI PHD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 12/14/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 N 10TH ST STE G
BLYTHEVILLE AR
72315
US

IV. Provider business mailing address

1521 N 10TH ST STE G
BLYTHEVILLE AR
72315
US

V. Phone/Fax

Practice location:
  • Phone: 870-763-0222
  • Fax: 870-763-0250
Mailing address:
  • Phone: 870-763-0222
  • Fax: 870-763-0250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberE0231
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: