Healthcare Provider Details

I. General information

NPI: 1609898006
Provider Name (Legal Business Name): STEPHEN C FIEDOREK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 COUNTRY CLUB ROAD
SHERWOOD AR
72120-5076
US

IV. Provider business mailing address

1525 COUNTRY CLUB ROAD
SHERWOOD AR
72120-5076
US

V. Phone/Fax

Practice location:
  • Phone: 501-758-1530
  • Fax: 501-819-6171
Mailing address:
  • Phone: 501-758-1530
  • Fax: 501-819-6171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberR3678
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: