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General NPI Number Information
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NPI Number | 1285780643
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Entity Type | Individual
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Provider Name | IMRAN WAHEED M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1600 W 40TH AVE
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City | PINE BLUFF
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State | AR
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Zip | 71603-6301
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Country | US
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Telephone | 870-541-7346
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Fax |
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Provider Business Mailing Address
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Address Line | 1305 HEARTWOOD ST
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City | WHITE HALL
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State | AR
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Zip | 71602-4779
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Country | US
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Telephone | 870-541-7347
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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 | E3944
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License Number State | AR
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