Provider Demographics
NPI:1033110556
Name:VALLERY, SAMUEL W (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:W
Last Name:VALLERY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:704 W GROVE ST STE 1
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-4469
Mailing Address - Country:US
Mailing Address - Phone:870-863-2368
Mailing Address - Fax:870-875-6233
Practice Address - Street 1:2212 MALVERN AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-8038
Practice Address - Country:US
Practice Address - Phone:501-609-2300
Practice Address - Fax:501-609-2301
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE0503207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
5J718OtherBCBS
ARP00470953OtherRAILROAD MEDICARE PTAN
16278000001OtherQUALCHOICE
AR166792002Medicaid
ARP00470953OtherRAILROAD MEDICARE PTAN
16278000001OtherQUALCHOICE
AR166792002Medicaid