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General NPI Number Information
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NPI Number | 1598077679
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Entity Type | Individual
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Provider Name | SUMANTH BALGURI MD, FAAFP
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Gender | Male
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Dates
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Enumeration Date | 07/06/2010
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Last Update Date | 07/10/2023
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Provider Practice Location Address
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Address Line | 7301 ROGERS AVE
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City | FORT SMITH
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State | AR
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Zip | 72903-4100
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Country | US
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Telephone | 479-314-6030
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Fax | 479-314-2021
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Provider Business Mailing Address
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Address Line | 7301 ROGERS AVE
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City | FORT SMITH
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State | AR
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Zip | 72903-4100
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Country | US
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Telephone | 479-314-6030
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Fax | 479-314-2021
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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 | 288945
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License Number State | NY
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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 | 27769
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | E-8115
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License Number State | AR
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