Provider Demographics
NPI:1407114978
Name:SAMUEL, PEARL ANNE (MBBS)
Entity Type:Individual
Prefix:DR
First Name:PEARL
Middle Name:ANNE
Last Name:SAMUEL
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 S 42ND ST STE
Mailing Address - Street 2:STE 100
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758
Mailing Address - Country:US
Mailing Address - Phone:479-273-9173
Mailing Address - Fax:
Practice Address - Street 1:2000 S 42ND ST
Practice Address - Street 2:SUIT 100
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-2001
Practice Address - Country:US
Practice Address - Phone:479-273-9173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-02
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ARE-9400207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program