Provider Demographics
NPI:1700845740
Name:SRA, SURINDER P S (MD)
Entity Type:Individual
Prefix:
First Name:SURINDER
Middle Name:P S
Last Name:SRA
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 1:197 HOSPITAL DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHEROKEE VLG
Mailing Address - State:AR
Mailing Address - Zip Code:72529-7314
Mailing Address - Country:US
Mailing Address - Phone:870-257-5118
Mailing Address - Fax:
Practice Address - Street 1:197 HOSPITAL DR
Practice Address - Street 2:SUITE B
Practice Address - City:CHEROKEE VLG
Practice Address - State:AR
Practice Address - Zip Code:72529-7314
Practice Address - Country:US
Practice Address - Phone:870-257-5118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE0496207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARG21149Medicare UPIN
AR5J966Medicare ID - Type Unspecified