Provider Demographics
NPI:1619912110
Name:MUELLER, PHUONG QVOC (DPM)
Entity Type:Individual
Prefix:
First Name:PHUONG
Middle Name:QVOC
Last Name:MUELLER
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 1:1105 SHIPLEY ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-5453
Mailing Address - Country:US
Mailing Address - Phone:479-756-2556
Mailing Address - Fax:479-756-5265
Practice Address - Street 1:1105 SHIPLEY ST
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-5453
Practice Address - Country:US
Practice Address - Phone:479-756-6334
Practice Address - Fax:479-756-6653
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2024-04-03
Deactivation Date:2022-12-29
Deactivation Code:
Reactivation Date:2024-04-03
Provider Licenses
StateLicense IDTaxonomies
AR159213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR131968717Medicaid
U64453Medicare UPIN
AR131968717Medicaid