Healthcare Provider Details

I. General information

NPI: 1275573750
Provider Name (Legal Business Name): MATTHEW D HULSEY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 12/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

248 HIGHWAY 70 E SUITE A
GLENWOOD AR
71943-8801
US

IV. Provider business mailing address

1661 AIRPORT RD SUITE D
HOT SPRINGS AR
71913-7951
US

V. Phone/Fax

Practice location:
  • Phone: 870-356-4801
  • Fax: 870-356-5467
Mailing address:
  • Phone: 501-625-7500
  • Fax: 501-625-7777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberN7783
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: