Provider Demographics
NPI:1265654727
Name:SAFFOLD, SARAH
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:SAFFOLD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 VINE ST
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-6700
Mailing Address - Country:US
Mailing Address - Phone:870-875-5124
Mailing Address - Fax:
Practice Address - Street 1:2700 VINE ST
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-6700
Practice Address - Country:US
Practice Address - Phone:870-875-5124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR150404721Medicaid
AR150404721Medicaid