Provider Demographics
NPI:1013098334
Name:TAGGART, SAMUEL D (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:D
Last Name:TAGGART
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 1:3 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015-3728
Mailing Address - Country:US
Mailing Address - Phone:501-778-0934
Mailing Address - Fax:501-778-1013
Practice Address - Street 1:3 MEDICAL PARK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-3728
Practice Address - Country:US
Practice Address - Phone:501-778-0934
Practice Address - Fax:501-778-1013
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC4775207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR105480001Medicaid
ARD83884Medicare UPIN
AR105480001Medicaid