Healthcare Provider Details

I. General information

NPI: 1427303437
Provider Name (Legal Business Name): DALAL FARID JACOB M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2012
Last Update Date: 07/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 CHEROKEE DR
NEWPORT AR
72112-9998
US

IV. Provider business mailing address

1224 CHEROKEE DR
NEWPORT AR
72112-9998
US

V. Phone/Fax

Practice location:
  • Phone: 870-523-5360
  • Fax:
Mailing address:
  • Phone: 870-523-5360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License NumberR-3150
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberR-3150
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License NumberR-3150
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: