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General NPI Number Information
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NPI Number | 1760448542
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Entity Type | Organization
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Legal Business Name | ARKANSAS CANCER CLINIC, PA
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Dates
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Enumeration Date | 04/21/2006
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Last Update Date | 12/17/2009
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Provider Practice Location Address
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Address Line | 7200 SOUTH HAZEL
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City | PINE BLUFF
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State | AR
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Zip | 71603
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Country | US
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Telephone | 870-535-2800
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Fax | 870-535-2801
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Provider Business Mailing Address
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Address Line | PO BOX 8906
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City | PINE BLUFF
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State | AR
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Zip | 71611
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Country | US
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Telephone | 870-535-2800
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Fax | 870-535-2801
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Authorized Official
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Title or Position | PRESIDENT
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Name | OMAR TAIMOOR ATIQ
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Credential | MD
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Telephone | 870-535-2800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | R4174
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License Number State | AR
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