Healthcare Provider Details

I. General information

NPI: 1902885015
Provider Name (Legal Business Name): SUMNER R CULLOM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W KEISER AVE
OSCEOLA AR
72370-3506
US

IV. Provider business mailing address

PO BOX 1331
JONESBORO AR
72403-1331
US

V. Phone/Fax

Practice location:
  • Phone: 870-563-0757
  • Fax: 870-563-0754
Mailing address:
  • Phone: 870-932-7024
  • Fax: 870-930-9377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberARC4583
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: