Provider Demographics
NPI:1639497712
Name:HAMID MUMTAZ, MD PA
Entity type:Organization
Organization Name:HAMID MUMTAZ, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAMID
Authorized Official - Middle Name:
Authorized Official - Last Name:MUMTAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-558-9093
Mailing Address - Street 1:500 S UNIVERSITY AVE STE 508
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5306
Mailing Address - Country:US
Mailing Address - Phone:501-558-9093
Mailing Address - Fax:501-588-1750
Practice Address - Street 1:500 S UNIVERSITY AVE STE 508
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5306
Practice Address - Country:US
Practice Address - Phone:501-558-9093
Practice Address - Fax:501-588-1750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-13
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE3401208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty