Provider Demographics
NPI:1306157037
Name:AMAN, MUAZZUM (MD)
Entity type:Individual
Prefix:DR
First Name:MUAZZUM
Middle Name:
Last Name:AMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 S MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-7000
Mailing Address - Country:US
Mailing Address - Phone:870-541-6008
Mailing Address - Fax:870-541-3198
Practice Address - Street 1:4010 S MULBERRY ST
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-7000
Practice Address - Country:US
Practice Address - Phone:870-541-6008
Practice Address - Fax:870-541-3198
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA136647207P00000X
ARE-7232207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine