Provider Demographics
NPI:1437166774
Name:HIGHSMITH, VIVIAN FAYE (MD)
Entity Type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:FAYE
Last Name:HIGHSMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 SCHNEIDER DR
Mailing Address - Street 2:ER
Mailing Address - City:MALVERN
Mailing Address - State:AR
Mailing Address - Zip Code:72104-4811
Mailing Address - Country:US
Mailing Address - Phone:501-332-7355
Mailing Address - Fax:501-332-7044
Practice Address - Street 1:1001 SCHNEIDER DR
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:AR
Practice Address - Zip Code:72104-4811
Practice Address - Country:US
Practice Address - Phone:501-332-7355
Practice Address - Fax:501-332-7044
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC6149207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR110969001Medicaid
AR110969001Medicaid
ARB90304Medicare UPIN
AR52378Medicare PIN