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Individual

DR. PHETSAMONE PETER XAYSANASY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.P.M.

Contact information

Practice address
125 W SUNBRIDGE DR, SUITE 1, FAYETTEVILLE, AR 72703-1899
(479) 251-9200
Mailing address
125 W SUNBRIDGE DR, SUITE 1, FAYETTEVILLE, AR 72703-1899
(479) 251-9200

Taxonomy

Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
193
AR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
14086717
AR
Enumeration date
06/16/2006
Last updated
01/03/2011
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