Provider Demographics
NPI:1922285147
Name:VAFA FERDOWSIAN DPM, P.A.
Entity Type:Organization
Organization Name:VAFA FERDOWSIAN DPM, P.A.
Other - Org Name:FOOT AND ANKLE SPECIALTY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:VAFA
Authorized Official - Middle Name:N
Authorized Official - Last Name:FERDOWSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:501-327-3668
Mailing Address - Street 1:PO BOX 10607
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-0010
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-30
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR230213ES0103X
332900000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332900000XSuppliersNon-Pharmacy Dispensing SiteGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR05080020101OtherQUALCHOICE INDIVIDUAL NUM
AR201228716Medicaid
AR156810717Medicaid
ARP00304134OtherRAILROAD MEDICARE NUMBER
AR163819748Medicaid
AR5764142OtherCIGNA INDIVIDUAL NUMBER
AR5N327OtherBLUE CROSS BLUE SHIELD
ARP00304134OtherRAILROAD MEDICARE NUMBER
ARV01742Medicare UPIN