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General NPI Number Information
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NPI Number | 1033593629
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Entity Type | Individual
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Provider Name | YEVHENIY LIDER MD
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Gender | Male
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Dates
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Enumeration Date | 07/14/2015
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Last Update Date | 05/21/2025
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Provider Practice Location Address
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Address Line | 620 N MAIN ST
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City | HARRISON
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State | AR
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Zip | 72601-2911
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Country | US
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Telephone | 870-414-4000
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Fax | 870-414-4949
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Provider Business Mailing Address
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Address Line | 5665 NEW NORTHSIDE DR STE 320
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City | ATLANTA
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State | GA
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Zip | 30328-5834
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Country | US
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Telephone | 404-265-4450
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 2024001361
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 79977
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | E19128
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License Number State | AR
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