Organization
CONWAY OB-GYN CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBIN CAROL FAGALA (PRACTICE MANAGER)
(501) 327-6547
Entity
Organization
Contact information
Practice address
2180 ADA AVENUE, SUITE 300, CONWAY, AR 72034-6135
(501) 327-6547
(501) 327-9715
Mailing address
2180 ADA AVENUE, SUITE 300, CONWAY, AR 72034-6135
(501) 327-6547
(501) 327-9715
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
115352002
—
AR
Enumeration date
03/21/2006
Last updated
11/04/2020
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