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General NPI Number Information
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NPI Number | 1396244505
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Entity Type | Organization
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Legal Business Name | VITRUVIAN DIETARY SOLUTIONS, PLLC
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Dates
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Enumeration Date | 02/03/2018
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Last Update Date | 06/19/2019
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Provider Practice Location Address
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Address Line | 2007 E NETTLETON AVE STE B
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City | JONESBORO
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State | AR
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Zip | 72401-5286
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Country | US
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Telephone | 870-520-5013
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Fax | 870-520-5020
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Provider Business Mailing Address
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Address Line | 2007 E NETTLETON AVE STE B
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City | JONESBORO
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State | AR
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Zip | 72401-5286
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Country | US
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Telephone | 870-520-5013
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Fax | 870-520-5020
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Authorized Official
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Title or Position | OWNER
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Name | BRADFORD STEWARD
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Credential | M.D.
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Telephone | 479-799-5520
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083B0002X
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Taxonomy Name | Obesity Medicine (Preventive Medicine) Physician
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License Number | E-7271
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | E-7271
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License Number State | AR
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