Healthcare Provider Details

I. General information

NPI: 1679145460
Provider Name (Legal Business Name): MOHAMMAD MAHMOUD IBRAHIM SAMARA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2021
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 SAINT VINCENT CIR
LITTLE ROCK AR
72205-5423
US

IV. Provider business mailing address

2 SAINT VINCENT CIR
LITTLE ROCK AR
72205-5423
US

V. Phone/Fax

Practice location:
  • Phone: 501-552-3000
  • Fax:
Mailing address:
  • Phone: 501-552-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberE-20028
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: