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General NPI Number Information
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NPI Number | 1578043394
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Entity Type | Organization
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Legal Business Name | LG SASSER III MD LLC
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Dates
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Enumeration Date | 08/21/2018
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Last Update Date | 08/21/2018
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Provider Practice Location Address
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Address Line | 1200 FORT ST
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City | BARLING
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State | AR
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Zip | 72923-2013
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Country | US
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Telephone | 479-763-1511
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Fax | 479-358-1455
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Provider Business Mailing Address
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Address Line | PO BOX 1446
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City | ALMA
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State | AR
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Zip | 72921-1446
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Country | US
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Telephone | 479-430-8503
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Fax | 479-358-1455
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Authorized Official
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Title or Position | OWNER
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Name | LOUIS GORDON SASSER
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Credential | MD
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Telephone | 479-430-8503
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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 |
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License Number State | AR
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