Organization
FORT NEURO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY Y MARYANOV MD (OWNER)
(479) 242-3310
Entity
Organization
Contact information
Practice address
1501 S WALDRON RD STE 109, FORT SMITH, AR 72903-2568
(479) 242-3310
(479) 439-8868
Mailing address
1501 S WALDRON RD STE 109, FORT SMITH, AR 72903-2568
(479) 242-3310
(479) 439-8868
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
—
—
208VP0014X
Interventional Pain Medicine Physician
—
—
Other
Enumeration date
10/11/2017
Last updated
10/11/2017
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