Provider Demographics
NPI:1821544628
Name:NAUMAN YUNUS MD PA
Entity Type:Organization
Organization Name:NAUMAN YUNUS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NAUMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:YUNUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-692-6627
Mailing Address - Street 1:PO BOX 1572
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71613-1572
Mailing Address - Country:US
Mailing Address - Phone:870-692-6627
Mailing Address - Fax:
Practice Address - Street 1:1600 WEST 40TH AVE
Practice Address - Street 2:JEFFERSON REGIONAL MEDICAL CENTER
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603
Practice Address - Country:US
Practice Address - Phone:870-541-7650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE0891207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR130203001Medicaid
AR5K173Medicare PIN