Provider Demographics
NPI:1710993654
Name:FEDOSKY, SCOTT DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:DAVID
Last Name:FEDOSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 6220
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72766-6220
Mailing Address - Country:US
Mailing Address - Phone:479-927-3100
Mailing Address - Fax:479-927-3131
Practice Address - Street 1:5230 WILLOW CREEK DR STE 201
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-0899
Practice Address - Country:US
Practice Address - Phone:479-927-3131
Practice Address - Fax:479-927-3131
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE 0546208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5I580Medicare UPIN