Healthcare Provider Details

I. General information

NPI: 1962407940
Provider Name (Legal Business Name): AMMAR AL-HALLAK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 04/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E OAK AVE
JONESBORO AR
72401
US

IV. Provider business mailing address

201 E OAK AVE
JONESBORO AR
72401
US

V. Phone/Fax

Practice location:
  • Phone: 870-935-6729
  • Fax: 870-268-4410
Mailing address:
  • Phone: 870-935-6729
  • Fax: 870-268-4410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberE2374
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: