Healthcare Provider Details

I. General information

NPI: 1922285147
Provider Name (Legal Business Name): VAFA FERDOWSIAN DPM, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2008
Last Update Date: 09/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 HOGAN LN STE B
CONWAY AR
72034-8216
US

IV. Provider business mailing address

PO BOX 10607
CONWAY AR
72034-0010
US

V. Phone/Fax

Practice location:
  • Phone: 501-327-3668
  • Fax: 501-327-3664
Mailing address:
  • Phone: 501-327-3668
  • Fax: 501-327-3664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number230
License Number StateAR

VIII. Authorized Official

Name: VAFA N FERDOWSIAN
Title or Position: OWNER/PHYSICIAN
Credential: DPM
Phone: 501-327-3668