Healthcare Provider Details

I. General information

NPI: 1710909098
Provider Name (Legal Business Name): NASIM A KHAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 12/05/2022
Certification Date: 12/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10001 LILE DR
LITTLE ROCK AR
72205-6217
US

IV. Provider business mailing address

PO BOX 23410
LITTLE ROCK AR
72221-3410
US

V. Phone/Fax

Practice location:
  • Phone: 501-552-0500
  • Fax: 501-604-8758
Mailing address:
  • Phone: 501-224-1690
  • Fax: 501-224-1927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberE-5873
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: