Healthcare Provider Details

I. General information

NPI: 1811339054
Provider Name (Legal Business Name): SAMIR VITTHALBHAI PATEL MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2013
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 LEXINGTON AVE
FORT SMITH AR
72901-5136
US

IV. Provider business mailing address

1120 LEXINGTON AVE
FORT SMITH AR
72901-5136
US

V. Phone/Fax

Practice location:
  • Phone: 479-709-7260
  • Fax:
Mailing address:
  • Phone: 479-709-7260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number39696
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberE-9994
License Number StateAR
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number39696
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: