Healthcare Provider Details

I. General information

NPI: 1336645225
Provider Name (Legal Business Name): ZOLTAN VARGA M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2018
Last Update Date: 05/09/2022
Certification Date: 05/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2205 W MAIN ST
RUSSELLVILLE AR
72801-2759
US

IV. Provider business mailing address

2205 W MAIN ST
RUSSELLVILLE AR
72801-2759
US

V. Phone/Fax

Practice location:
  • Phone: 479-968-4311
  • Fax: 479-968-4399
Mailing address:
  • Phone: 479-968-4311
  • Fax: 479-968-4399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberE-14700
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: