Healthcare Provider Details

I. General information

NPI: 1932548344
Provider Name (Legal Business Name): SAMEER JAIN M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2013
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 OFFICE PARK DR STE 3
BRYANT AR
72022-7536
US

IV. Provider business mailing address

408 OFFICE PARK DR STE 3
BRYANT AR
72022-7536
US

V. Phone/Fax

Practice location:
  • Phone: 501-553-0000
  • Fax: 501-600-4781
Mailing address:
  • Phone: 501-553-0000
  • Fax: 501-600-4781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD461254
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberE11173
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: