Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 230 | AR |
NPI | 1033182837 |
---|---|
Provider Name | Vafa N Ferdowsian |
First Address | Conway, AR 72034-5107 |
Second Address | Conway, AR 72034-8216 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2006 |
Last Update Date | 02/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
05080020100 | QUALCHOICE INDIVIDUAL NUM (01) | AR |
156810717 | (05) | AR |
5764142 | CIGNA INDIVIDUAL NUMBER (01) | AR |
5N327 | BCBS INDIVIDUAL NUMBER (01) | AR |
7176701 | AETNA NUMBER (01) | AR |
P00304134 | RAILROAD MEDICARE NUMBER (01) | AR |
V01742 | (02) | AR |