Healthcare Provider Details

I. General information

NPI: 1861874489
Provider Name (Legal Business Name): PAUL W. HANNAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2015
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 W 40TH AVE STE 100
PINE BLUFF AR
71603-6069
US

IV. Provider business mailing address

1601 W 40TH AVE STE 100
PINE BLUFF AR
71603-6069
US

V. Phone/Fax

Practice location:
  • Phone: 870-541-6000
  • Fax: 870-541-7618
Mailing address:
  • Phone: 870-541-6000
  • Fax: 870-541-7618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE-21022
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: