Healthcare Provider Details

I. General information

NPI: 1972061430
Provider Name (Legal Business Name): VAFA FERDOWSIAN DPM, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2019
Last Update Date: 03/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1713 W MAIN ST
RUSSELLVILLE AR
72801-2721
US

IV. Provider business mailing address

PO BOX 10607
CONWAY AR
72034-0010
US

V. Phone/Fax

Practice location:
  • Phone: 800-539-1911
  • Fax: 501-327-3664
Mailing address:
  • Phone: 501-327-3668
  • Fax: 501-327-3664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: VAFA N FERDOWSIAN
Title or Position: OWNER
Credential: DPM
Phone: 501-327-3668