Healthcare Provider Details

I. General information

NPI: 1093986358
Provider Name (Legal Business Name): SOUTH ARKANSAS HEMATOLOGY & ONCOLOGY CLINIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2008
Last Update Date: 10/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1716 DOCTOR DR.
PINE BLUFF AR
71603-6367
US

IV. Provider business mailing address

1716 DOCTOR DR
PINE BLUFF AR
71603-6367
US

V. Phone/Fax

Practice location:
  • Phone: 870-534-1188
  • Fax: 870-534-0188
Mailing address:
  • Phone: 870-534-1188
  • Fax: 870-534-0188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberC8506
License Number StateAR

VIII. Authorized Official

Name: MOHAMMAD BILAL MALIK
Title or Position: PRESIDENT
Credential:
Phone: 870-534-1188