Healthcare Provider Details

I. General information

NPI: 1992740393
Provider Name (Legal Business Name): FAYZ A HUDEFI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 11/21/2022
Certification Date: 04/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 TOWSON AVE FL 6
FORT SMITH AR
72901-4921
US

IV. Provider business mailing address

11001 EXECUTIVE CENTER DR STE 200
LITTLE ROCK AR
72211-4393
US

V. Phone/Fax

Practice location:
  • Phone: 479-441-5601
  • Fax: 479-709-7423
Mailing address:
  • Phone: 479-441-5601
  • Fax: 479-521-6520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberE-4773
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberE4773
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: