Provider Demographics
NPI:1376816850
Name:CANZONERI MFM, PLLC
Entity Type:Organization
Organization Name:CANZONERI MFM, PLLC
Other - Org Name:MATERNAL-FETAL MEDICINE CENTER OF NORTHWEST ARKANSAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:M.D./ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:CANZONERI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-443-4500
Mailing Address - Street 1:5501 WILLOW CREEK DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-8704
Mailing Address - Country:US
Mailing Address - Phone:479-443-4500
Mailing Address - Fax:479-443-4502
Practice Address - Street 1:5501 WILLOW CREEK DR
Practice Address - Street 2:SUITE 202
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-8704
Practice Address - Country:US
Practice Address - Phone:479-443-4500
Practice Address - Fax:479-443-4502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-15
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-7297207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Single Specialty