Healthcare Provider Details

I. General information

NPI: 1043201940
Provider Name (Legal Business Name): JAMAL ZIAD ABDIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 02/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 E MAIN ST
FARMINGTON AR
72730-3023
US

IV. Provider business mailing address

199 E MAIN ST
FARMINGTON AR
72730-3023
US

V. Phone/Fax

Practice location:
  • Phone: 479-267-1001
  • Fax: 479-267-1026
Mailing address:
  • Phone: 479-267-1001
  • Fax: 479-267-1026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE3510
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: