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General NPI Number Information
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NPI Number | 1639487564
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Entity Type | Organization
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Legal Business Name | SHAMSUL ALAM MD PA
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Dates
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Enumeration Date | 09/14/2010
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Last Update Date | 03/02/2016
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Provider Practice Location Address
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Address Line | 2618 SE J ST SUITE#4
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City | BENTONVILLE
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State | AR
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Zip | 72712-3767
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Country | US
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Telephone | 479-271-9393
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Fax | 479-271-9393
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Provider Business Mailing Address
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Address Line | PO BOX 1037
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City | BENTONVILLE
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State | AR
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Zip | 72712-1037
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Country | US
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Telephone | 479-271-9393
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Fax | 479-271-0141
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SHAMSUL ALAM
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Credential | M.D.
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Telephone | 479-271-9393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | E4954
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License Number State | AR
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