Provider Demographics
NPI:1922627249
Name:DESAI, VAIBHAV S (MD)
Entity Type:Individual
Prefix:
First Name:VAIBHAV
Middle Name:S
Last Name:DESAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UAMS-WEST
Mailing Address - Street 2:612 SOUTH 12TH ST.
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901
Mailing Address - Country:US
Mailing Address - Phone:479-785-2431
Mailing Address - Fax:479-785-0732
Practice Address - Street 1:18910 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-7711
Practice Address - Country:US
Practice Address - Phone:305-585-9230
Practice Address - Fax:305-355-2930
Is Sole Proprietor?:No
Enumeration Date:2020-04-16
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME161119207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program