Provider Demographics
NPI:1285631473
Name:AHMED, SAHIBZADA A (MD)
Entity Type:Individual
Prefix:
First Name:SAHIBZADA
Middle Name:A
Last Name:AHMED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 539
Mailing Address - Street 2:
Mailing Address - City:BOONEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72927-0539
Mailing Address - Country:US
Mailing Address - Phone:479-675-5283
Mailing Address - Fax:479-675-4842
Practice Address - Street 1:880 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BOONEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72927-3420
Practice Address - Country:US
Practice Address - Phone:479-675-2800
Practice Address - Fax:479-675-5291
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR2870208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR50064Medicare ID - Type Unspecified
ARD83878Medicare UPIN