Provider Demographics
NPI:1366501108
Name:PRICE, SAMUEL WESLEY SR (DO)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:WESLEY
Last Name:PRICE
Suffix:SR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 WILLARD ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-5989
Mailing Address - Country:US
Mailing Address - Phone:479-841-9203
Mailing Address - Fax:479-927-0198
Practice Address - Street 1:1900 WILLARD ST
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-5989
Practice Address - Country:US
Practice Address - Phone:479-841-9203
Practice Address - Fax:479-927-0198
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARN-7372208D00000X, 207Q00000X
OK1805208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice