Healthcare Provider Details

I. General information

NPI: 1063402519
Provider Name (Legal Business Name): STEPHEN PATRICK PENOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3633 CENTRAL AVENUE SUITE D
HOT SPRINGS AR
71913-6475
US

IV. Provider business mailing address

3633 CENTRAL AVENUE SUITE D
HOT SPRINGS AR
71913-6475
US

V. Phone/Fax

Practice location:
  • Phone: 501-623-6693
  • Fax: 501-623-9403
Mailing address:
  • Phone: 501-623-6693
  • Fax: 501-623-9403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberE3410
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License NumberE-3410
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberV7274
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberE-3410
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: