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General NPI Number Information
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NPI Number | 1245409135
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Entity Type | Individual
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Provider Name | SAMSON OLAITAN MD
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Gender | Male
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Dates
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Enumeration Date | 02/25/2008
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Last Update Date | 10/15/2025
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Provider Practice Location Address
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Address Line | 1993 HARRISON ST STE 302
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City | BATESVILLE
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State | AR
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Zip | 72501-7309
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Country | US
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Telephone | 870-793-2540
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Fax |
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Provider Business Mailing Address
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Address Line | 1993 HARRISON ST
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City | BATESVILLE
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State | AR
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Zip | 72501-7309
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Country | US
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Telephone | 870-793-2540
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | E-19944
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | C0003400
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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