Healthcare Provider Details

I. General information

NPI: 1033110556
Provider Name (Legal Business Name): SAMUEL W VALLERY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 09/09/2020
Certification Date: 09/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2212 MALVERN AVE SUITE 8
HOT SPRINGS AR
71901-8038
US

IV. Provider business mailing address

704 W GROVE ST STE 1
EL DORADO AR
71730-4469
US

V. Phone/Fax

Practice location:
  • Phone: 501-609-2300
  • Fax: 501-609-2301
Mailing address:
  • Phone: 870-863-2368
  • Fax: 870-875-6233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberE0503
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: