Healthcare Provider Details

I. General information

NPI: 1043251762
Provider Name (Legal Business Name): PODIATRY GROUP THE FOOT DOCTORS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 12/29/2020
Certification Date: 12/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

637 E MATTHEWS AVE
JONESBORO AR
72401-3145
US

IV. Provider business mailing address

637 E MATTHEWS AVE
JONESBORO AR
72401-3145
US

V. Phone/Fax

Practice location:
  • Phone: 870-931-3338
  • Fax: 870-935-9084
Mailing address:
  • Phone: 870-931-3338
  • Fax: 870-935-9084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK EDWARD REINER
Title or Position: PRESIDENT
Credential: D.P.M.
Phone: 870-931-3338