MEDICARE: EAST ARKANSAS FOOT SPECIALISTS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	120	AR

General Provider Information

NPI Number	:	1063757490
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST ARKANSAS FOOT SPECIALISTS

Provider Business Mailing Address
First Line	:	401 GRAHAM ST
Second Line	:
City	:	WEST MEMPHIS
State	:	AR
Zip	:	72301-3117
Country	:	US
Telephone Number	:	870-735-6500
Fax Number	:	870-735-4442

Provider Business Practice Location Address
First Line	:	401 GRAHAM ST
Second Line	:
City	:	WEST MEMPHIS
State	:	AR
Zip	:	72301-3117
Country	:	US
Telephone Number	:	870-735-6500
Fax Number	:	870-735-4442

Authorized Official
Title or Position	:	SECY/TEASURER
Name	:	DR. STEPHEN H. ZIMMERMAN
Credential	:	DPM
Telephone Number	:	870-735-6500

Provider Enumeration Date	:	12/12/2012
Last Update Date	:	01/26/2016

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