Healthcare Provider Details

I. General information

NPI: 1306816137
Provider Name (Legal Business Name): ARKANSAS FOOT CLINIC, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 01/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 ALDERSGATE RD
LITTLE ROCK AR
72205-6611
US

IV. Provider business mailing address

PO BOX 26508
LITTLE ROCK AR
72221-6501
US

V. Phone/Fax

Practice location:
  • Phone: 501-224-1501
  • Fax: 501-376-7065
Mailing address:
  • Phone: 501-224-1501
  • Fax: 501-376-7065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number StateAR

VIII. Authorized Official

Name: DR. ALLAN G GOLD
Title or Position: OWNER
Credential: DPM
Phone: 501-224-1501