Healthcare Provider Details

I. General information

NPI: 1962465740
Provider Name (Legal Business Name): CHETNA SHAILESH VORA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 12/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

253 SOUTH CONCORD
STRONG AR
71765
US

IV. Provider business mailing address

PO BOX 851
HAMPTON AR
71744-0851
US

V. Phone/Fax

Practice location:
  • Phone: 870-797-7620
  • Fax: 870-797-2459
Mailing address:
  • Phone: 870-798-3515
  • Fax: 870-798-2005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR-4132
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: