Basic Information
| Provider Information | |||||||||
| NPI: | 1932548344 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JAIN | ||||||||
| FirstName: | SAMEER | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 108 N SHACKLEFORD RD | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722112840 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5017122571 | ||||||||
| FaxNumber: | 5014047789 | ||||||||
| Practice Location | |||||||||
| Address1: | 7211 DOLLARWAY RD | ||||||||
| Address2: | |||||||||
| City: | WHITE HALL | ||||||||
| State: | AR | ||||||||
| PostalCode: | 716023020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8442150731 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2013 | ||||||||
| LastUpdateDate: | 04/05/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | MD461254 | PA | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 390200000X | MT204432 | PA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2084P2900X | E11173 | AR | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Pain Medicine |
No ID Information.