Healthcare Provider Details

I. General information

NPI: 1235778515
Provider Name (Legal Business Name): ARKANSAS VASCULAR SURGERY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2020
Last Update Date: 02/10/2020
Certification Date: 02/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11300 N RODNEY PARHAM RD STE 210
LITTLE ROCK AR
72212-4149
US

IV. Provider business mailing address

11300 N RODNEY PARHAM RD STE 210
LITTLE ROCK AR
72212-4149
US

V. Phone/Fax

Practice location:
  • Phone: 501-251-7787
  • Fax:
Mailing address:
  • Phone: 501-313-1001
  • Fax: 501-663-4145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SCOTT JAMES RYAN
Title or Position: OWNER/VASCULAR SURGEON
Credential: MD
Phone: 501-251-7787