Healthcare Provider Details

I. General information

NPI: 1285253641
Provider Name (Legal Business Name): ERIC NGUYEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2020
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 TOWSON AVE
FORT SMITH AR
72901-4921
US

IV. Provider business mailing address

612 S 12TH ST
FORT SMITH AR
72901-4702
US

V. Phone/Fax

Practice location:
  • Phone: 479-441-4000
  • Fax:
Mailing address:
  • Phone: 479-785-2431
  • Fax: 479-785-0732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE14995
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberE14995
License Number StateAR
# 4
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberV7598
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: