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General NPI Number Information
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NPI Number | 1265497242
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Entity Type | Individual
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Provider Name | SANJAY REUBEN DASS MD
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Gender | Male
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Dates
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Enumeration Date | 04/20/2006
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Last Update Date | 09/27/2024
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Provider Practice Location Address
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Address Line | 16221 SAINT VINCENT WAY
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City | LITTLE ROCK
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State | AR
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Zip | 72223-9072
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Country | US
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Telephone | 501-552-8150
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Fax | 501-552-8199
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Provider Business Mailing Address
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Address Line | 16221 SAINT VINCENT WAY
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City | LITTLE ROCK
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State | AR
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Zip | 72223-9072
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Country | US
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Telephone | 501-552-8150
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Fax | 501-552-8199
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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 | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | E-4008
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | E4008
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License Number State | AR
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