Provider Demographics
NPI:1053411942
Name:ALAM, EJAZ (MD)
Entity type:Individual
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First Name:EJAZ
Middle Name:
Last Name:ALAM
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Gender:M
Credentials:MD
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Mailing Address - Street 1:11001 EXECUTIVE CENTER DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4393
Mailing Address - Country:US
Mailing Address - Phone:501-812-7215
Mailing Address - Fax:501-812-7207
Practice Address - Street 1:9601 BAPTIST HEALTH DRIVE
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6321
Practice Address - Country:US
Practice Address - Phone:501-851-7402
Practice Address - Fax:501-851-4753
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2020-02-13
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Provider Licenses
StateLicense IDTaxonomies
ARE4578207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR162025001Medicaid