Organization
WALDRON PLACE PEDIATRIC CLINIC, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FEDERICO CARLOS DE MIRANDA M.D. (OWNER)
(479) 452-8311
Entity
Organization
Contact information
Practice address
1501 S WALDRON RD STE 202, FORT SMITH, AR 72903-2598
(479) 452-8311
(479) 452-5032
Mailing address
1501 S WALDRON RD STE 202, FORT SMITH, AR 72903-2598
(479) 452-8311
(479) 452-5032
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
C-5393
AR
Other
Enumeration date
03/06/2007
Last updated
08/22/2020
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