Healthcare Provider Details

I. General information

NPI: 1942243787
Provider Name (Legal Business Name): REEL FAMILY FOOT CLINIC, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 08/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E PARKWAY DR
RUSSELLVILLE AR
72801-3913
US

IV. Provider business mailing address

PO BOX 9178
RUSSELLVILLE AR
72811-9178
US

V. Phone/Fax

Practice location:
  • Phone: 479-880-2600
  • Fax: 479-880-8076
Mailing address:
  • Phone: 479-968-4273
  • Fax: 479-968-1363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number215
License Number StateAR

VIII. Authorized Official

Name: JASON CARROLL REEL
Title or Position: DPM
Credential: DPM
Phone: 479-880-2600