Provider Demographics
NPI:1205296043
Name:ARKANSAS LIVER AND GASTROENTEROLOGY
Entity type:Organization
Organization Name:ARKANSAS LIVER AND GASTROENTEROLOGY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IHAB
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRAKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:472-242-2894
Mailing Address - Street 1:3416 OLD GREENWOOD RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-5462
Mailing Address - Country:US
Mailing Address - Phone:479-242-2894
Mailing Address - Fax:
Practice Address - Street 1:3416 OLD GREENWOOD RD
Practice Address - Street 2:SUITE A
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-5462
Practice Address - Country:US
Practice Address - Phone:479-242-2894
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARKANSAS LIVER AND GASTROENTEROLOGY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-04
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR20829333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy