Provider Demographics
NPI:1336115740
Name:SOOMAN, SANDRA ANN K (MD)
Entity Type:Individual
Prefix:
First Name:SANDRA ANN
Middle Name:K
Last Name:SOOMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOPE
Mailing Address - State:AR
Mailing Address - Zip Code:71801-6525
Mailing Address - Country:US
Mailing Address - Phone:870-722-6568
Mailing Address - Fax:870-722-6353
Practice Address - Street 1:900 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HOPE
Practice Address - State:AR
Practice Address - Zip Code:71801-6525
Practice Address - Country:US
Practice Address - Phone:870-722-6568
Practice Address - Fax:870-722-6353
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-4344208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR155640001Medicaid