Provider Demographics
NPI:1780803015
Name:CHINWAH, JUSTIN EZEKWEM (MD)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:EZEKWEM
Last Name:CHINWAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 11880
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72917-1880
Mailing Address - Country:US
Mailing Address - Phone:479-452-1581
Mailing Address - Fax:
Practice Address - Street 1:2301 S 56TH ST
Practice Address - Street 2:SUITE 110
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-3755
Practice Address - Country:US
Practice Address - Phone:479-452-1581
Practice Address - Fax:479-452-2148
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-5631207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology