NPI 1124089222 · live from the CMS NPI Registry
Randy M Ennen, M.D.
Ophthalmology in Fort Smith, AR. National Provider Identifier 1124089222, active.
NPI record
| NPI | 1124089222 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Ophthalmology 207W00000X |
| Practice location | 3312 S 70th St, Fort Smith, AR 72903 |
| Practice phone | 479-452-7800 |
| Enumerated | March 29, 2006 |
| Last updated | March 18, 2021 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Ophthalmology primary | 207W00000X | N7403 (AR) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.