Provider Demographics
NPI:1043708282
Name:NOYDEEN MEDICAL GROUP BRYANT
Entity Type:Organization
Organization Name:NOYDEEN MEDICAL GROUP BRYANT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-575-0081
Mailing Address - Street 1:2301 SPRINGHILL RD STE 110
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72019-7573
Mailing Address - Country:US
Mailing Address - Phone:501-575-0081
Mailing Address - Fax:
Practice Address - Street 1:2301 SPRINGHILL RD STE 110
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72019-7573
Practice Address - Country:US
Practice Address - Phone:501-575-0081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NOYDEEN SISTERS MEDICAL GROUP & CLINICS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-7341207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR219630002Medicaid