Healthcare Provider Details

I. General information

NPI: 1306157037
Provider Name (Legal Business Name): MUAZZUM AMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2010
Last Update Date: 09/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4010 S MULBERRY ST
PINE BLUFF AR
71603-7000
US

IV. Provider business mailing address

4010 S MULBERRY ST
PINE BLUFF AR
71603-7000
US

V. Phone/Fax

Practice location:
  • Phone: 870-541-6008
  • Fax: 870-541-3198
Mailing address:
  • Phone: 870-541-6008
  • Fax: 870-541-3198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA136647
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE-7232
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: