Healthcare Provider Details

I. General information

NPI: 1124098587
Provider Name (Legal Business Name): SAMUEL SCOTT BURCHFIELD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 01/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 W COURT ST
PARAGOULD AR
72450-4247
US

IV. Provider business mailing address

630 W COURT ST
PARAGOULD AR
72450-4247
US

V. Phone/Fax

Practice location:
  • Phone: 870-236-6911
  • Fax: 870-236-8129
Mailing address:
  • Phone: 870-236-6911
  • Fax: 870-236-8129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE1234
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: