Provider Demographics
NPI:1760458061
Name:ISKANDER, HENEIN T
Entity Type:Individual
Prefix:DR
First Name:HENEIN
Middle Name:T
Last Name:ISKANDER
Suffix:
Gender:M
Credentials:
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 749
Mailing Address - Street 2:
Mailing Address - City:FORREST CITY
Mailing Address - State:AR
Mailing Address - Zip Code:72336-0749
Mailing Address - Country:US
Mailing Address - Phone:870-633-7940
Mailing Address - Fax:870-630-6411
Practice Address - Street 1:900 HOLIDAY DR
Practice Address - Street 2:SUITE 105
Practice Address - City:FORREST CITY
Practice Address - State:AR
Practice Address - Zip Code:72335-9183
Practice Address - Country:US
Practice Address - Phone:870-633-7940
Practice Address - Fax:870-630-6411
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR3460208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR103575001Medicaid
AR103575001Medicaid
AR52588Medicare ID - Type UnspecifiedMEDICARE NUMBER