MEDICARE: DR. JUSTIN DAVID VORIS M.D.

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	207Q00000X	Family Medicine Physician	E8966	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	E8996	OTHER	AR	STATE LICENSE
2	44326	OTHER	OK	STATE LICENSE

General Provider Information

NPI Number	:	1356600829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUSTIN DAVID VORIS M.D.

Provider Business Mailing Address
First Line	:	6234 MASSARD RD STE 102
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72916-6153
Country	:	US
Telephone Number	:	479-269-4058
Fax Number	:	479-315-9162

Provider Business Practice Location Address
First Line	:	6234 MASSARD RD STE 102
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72916-6153
Country	:	US
Telephone Number	:	479-269-4058
Fax Number	:	479-315-9162

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2012
Last Update Date	:	09/24/2025

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