Healthcare Provider Details

I. General information

NPI: 1609457779
Provider Name (Legal Business Name): GINA VARGAS, M.D. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2021
Last Update Date: 08/13/2021
Certification Date: 08/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 ROGERS AVE
FORT SMITH AR
72903-3143
US

IV. Provider business mailing address

2916 KELLS ABBEY
FORT SMITH AR
72908-9317
US

V. Phone/Fax

Practice location:
  • Phone: 479-322-8272
  • Fax:
Mailing address:
  • Phone: 479-322-8272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. GINA VARGAS
Title or Position: PHYSICIAN
Credential: MD
Phone: 479-322-8272