Provider Demographics
NPI:1033182837
Name:FERDOWSIAN, VAFA N (DPM)
Entity Type:Individual
Prefix:
First Name:VAFA
Middle Name:N
Last Name:FERDOWSIAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 DONAGHEY AVE
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-5107
Mailing Address - Country:US
Mailing Address - Phone:501-327-3668
Mailing Address - Fax:501-327-3664
Practice Address - Street 1:1120 HOGAN LN STE B
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-8216
Practice Address - Country:US
Practice Address - Phone:501-327-3668
Practice Address - Fax:501-327-3664
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR230213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARP00304134OtherRAILROAD MEDICARE NUMBER
AR5764142OtherCIGNA INDIVIDUAL NUMBER
AR05080020100OtherQUALCHOICE INDIVIDUAL NUM
AR7176701OtherAETNA NUMBER
AR5N327OtherBCBS INDIVIDUAL NUMBER
AR156810717Medicaid
AR156810717Medicaid
ARP00304134OtherRAILROAD MEDICARE NUMBER
AR7176701OtherAETNA NUMBER