Healthcare Provider Details

I. General information

NPI: 1275057861
Provider Name (Legal Business Name): OREOLUWA D OLADIRAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2017
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4802 E JOHNSON AVE
JONESBORO AR
72405-8413
US

IV. Provider business mailing address

PO BOX 1960
JONESBORO AR
72403-1960
US

V. Phone/Fax

Practice location:
  • Phone: 870-936-8000
  • Fax: 870-934-3630
Mailing address:
  • Phone: 870-936-8000
  • Fax: 870-934-3670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberE-18640
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberE-18640
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: