Healthcare Provider Details

I. General information

NPI: 1225090038
Provider Name (Legal Business Name): VICTOR FRANCISCO COLOSO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 ROGERS AVE
FORT SMITH AR
72903-4100
US

IV. Provider business mailing address

PO BOX 11350
FORT SMITH AR
72917-1350
US

V. Phone/Fax

Practice location:
  • Phone: 479-314-4635
  • Fax: 479-314-4634
Mailing address:
  • Phone: 479-314-4635
  • Fax: 479-314-4634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberC2070
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC2070
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number01089436A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME70769
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: