MEDICARE: SAMUEL W VALLERY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	E0503	AR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00470953	OTHER	AR	RAILROAD MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	5J718	OTHER	BCBS
3	16278000001	OTHER	QUALCHOICE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033110556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL W VALLERY MD

Provider Business Mailing Address
First Line	:	704 W GROVE ST STE 1
Second Line	:
City	:	EL DORADO
State	:	AR
Zip	:	71730-4469
Country	:	US
Telephone Number	:	870-863-2368
Fax Number	:	870-875-6233

Provider Business Practice Location Address
First Line	:	2212 MALVERN AVE
Second Line	:	SUITE 8
City	:	HOT SPRINGS
State	:	AR
Zip	:	71901-8038
Country	:	US
Telephone Number	:	501-609-2300
Fax Number	:	501-609-2301

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	09/09/2020

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Directions to “ SAMUEL W VALLERY MD” Practice Location

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