Doctor Name: | DR. SCOTT DAVID FEDOSKY |
NPI Number: | 1710993654 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | E 0546 |
Business Practice Address: | 2603 Main Dr Suite # 6 Fayetteville, AR - 727045278 |
Business Phone Number: | 4795714325 |
Business Fax Number: | 4795714329 |
Mailing Address: | 2603 Main Dr, Suite # 6 FAYETTEVILLE |
State: | AR |
Postal Code: | 727045278 |
Phone Number: | 4795714325 |
Fax Number: | 4795714329 |
NPI Enumeration Date: | 07/31/2006 |
NPI Last Update Date: | 03/04/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | E 0546 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AR |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |