Provider Demographics
NPI:1821046608
Name:SANCHEZ, ILSA (MD)
Entity Type:Individual
Prefix:DR
First Name:ILSA
Middle Name:
Last Name:SANCHEZ
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 1:200 E MILITARY RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:AR
Mailing Address - Zip Code:72364-1811
Mailing Address - Country:US
Mailing Address - Phone:870-739-9300
Mailing Address - Fax:870-739-2209
Practice Address - Street 1:200 E MILITARY RD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:AR
Practice Address - Zip Code:72364-1811
Practice Address - Country:US
Practice Address - Phone:870-739-9300
Practice Address - Fax:870-739-2209
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR4284208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5J575OtherBLUE CROSS/ BLUE SHEILD
AR128069001Medicaid
AR5J575Medicare ID - Type Unspecified
AR5J575OtherBLUE CROSS/ BLUE SHEILD