Healthcare Provider Details

I. General information

NPI: 1295586329
Provider Name (Legal Business Name): MOHAMED MRAIYAN MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2024
Last Update Date: 03/29/2024
Certification Date: 03/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CARSON ST
JONESBORO AR
72401-3104
US

IV. Provider business mailing address

300 CARSON ST
JONESBORO AR
72401-3104
US

V. Phone/Fax

Practice location:
  • Phone: 870-910-7799
  • Fax: 870-336-2999
Mailing address:
  • Phone: 870-910-7799
  • Fax: 870-336-2999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: