Healthcare Provider Details

I. General information

NPI: 1902886914
Provider Name (Legal Business Name): SAMUEL EDWARD LANDRUM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 04/26/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 TOWSON AVE.
FORT SMITH AR
72901
US

IV. Provider business mailing address

PO BOX 1824
FORT SMITH AR
72902-1824
US

V. Phone/Fax

Practice location:
  • Phone: 479-441-5361
  • Fax: 479-441-5078
Mailing address:
  • Phone: 479-709-7399
  • Fax: 479-709-7053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberR1721
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: