Healthcare Provider Details

I. General information

NPI: 1396190401
Provider Name (Legal Business Name): RYAN DEWITZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2016
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 GENE GEORGE BLVD
SPRINGDALE AR
72762-0845
US

IV. Provider business mailing address

1 CHILDRENS WAY # 664
LITTLE ROCK AR
72202-3500
US

V. Phone/Fax

Practice location:
  • Phone: 479-725-6800
  • Fax: 479-725-6582
Mailing address:
  • Phone: 501-364-1100
  • Fax: 501-978-6436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberA171762
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberE-16698
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: