Healthcare Provider Details

I. General information

NPI: 1558306902
Provider Name (Legal Business Name): TARIK SIDANI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 12/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 W ERIE AVE
HARRISON AR
72601-3539
US

IV. Provider business mailing address

224 W ERIE AVE
HARRISON AR
72601-3539
US

V. Phone/Fax

Practice location:
  • Phone: 870-741-8289
  • Fax: 870-741-0308
Mailing address:
  • Phone: 870-741-8289
  • Fax: 870-741-0308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberE-5079
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: