Healthcare Provider Details

I. General information

NPI: 1053536060
Provider Name (Legal Business Name): STEPHEN M HUGHES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 07/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4375 N. VANTAGE DR. SUITE 305
FAYETTEVILLE AR
72703-4984
US

IV. Provider business mailing address

4375 N. VANTAGE DR. SUITE 305
FAYETTEVILLE AR
72703-4984
US

V. Phone/Fax

Practice location:
  • Phone: 479-443-5100
  • Fax: 479-443-5117
Mailing address:
  • Phone: 479-443-5100
  • Fax: 479-443-5117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberE4597
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberTL31228
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberE-4597
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: