Healthcare Provider Details

I. General information

NPI: 1740695410
Provider Name (Legal Business Name): IAN CHEYNE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2014
Last Update Date: 01/14/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 REGIONS PARK DR
FORT SMITH AR
72916-9373
US

IV. Provider business mailing address

4300 REGIONS PARK DR
FORT SMITH AR
72916-9373
US

V. Phone/Fax

Practice location:
  • Phone: 479-274-6300
  • Fax: 479-484-4715
Mailing address:
  • Phone: 479-274-6300
  • Fax: 479-484-4715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE-10398
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: