Healthcare Provider Details

I. General information

NPI: 1154423846
Provider Name (Legal Business Name): ASIM RAZA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 08/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 SALEM ROAD STE 1
CONWAY AR
72034
US

IV. Provider business mailing address

110 SKYLINE DR
RUSSELLVILLE AR
72801-3362
US

V. Phone/Fax

Practice location:
  • Phone: 501-336-8300
  • Fax: 501-329-3572
Mailing address:
  • Phone: 479-967-5570
  • Fax: 479-890-5364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberE1309
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: