Healthcare Provider Details

I. General information

NPI: 1316995202
Provider Name (Legal Business Name): JOHN CHARLES SAYRE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 07/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 LESLIE ST SUITE 1
NASHVILLE AR
71852-4017
US

IV. Provider business mailing address

900 LESLIE ST SUITE 1
NASHVILLE AR
71852-4017
US

V. Phone/Fax

Practice location:
  • Phone: 870-845-2201
  • Fax: 870-845-5031
Mailing address:
  • Phone: 870-845-2201
  • Fax: 870-845-5031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberR4285
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: