Provider Demographics
NPI:1154423846
Name:RAZA, ASIM (MD)
Entity type:Individual
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First Name:ASIM
Middle Name:
Last Name:RAZA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:110 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-3362
Mailing Address - Country:US
Mailing Address - Phone:479-967-5570
Mailing Address - Fax:479-890-5364
Practice Address - Street 1:350 SALEM ROAD
Practice Address - Street 2:STE 1
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034
Practice Address - Country:US
Practice Address - Phone:501-336-8300
Practice Address - Fax:501-329-3572
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2016-08-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ARE13092084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR132955001Medicaid
AR132955001Medicaid
AR132955001Medicaid