Provider Demographics
NPI:1003853862
Name:REGISTER, SAMUEL DAVID III (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:DAVID
Last Name:REGISTER
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3500 SPRINGHILL DR STE 200A
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72117-2948
Mailing Address - Country:US
Mailing Address - Phone:501-945-0392
Mailing Address - Fax:501-945-0394
Practice Address - Street 1:3500 SPRINGHILL DR STE 200A
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-2948
Practice Address - Country:US
Practice Address - Phone:501-202-3638
Practice Address - Fax:501-202-3639
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE7122207LP2900X, 2083P0011X, 2083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR189827001Medicaid
NC89132G6Medicaid
GA000393005CMedicaid
AR5I097OtherBCBS
NCE27994Medicare UPIN
AR5AM61G323Medicare PIN
NC89132G6Medicaid