Healthcare Provider Details

I. General information

NPI: 1548722028
Provider Name (Legal Business Name): STEPHEN L BODEMANN M.D. LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2019
Last Update Date: 04/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1636 HIGDON FERRY ROAD
HOT SPRINGS AR
71913
US

IV. Provider business mailing address

229 FOREST HEIGHTS TR
HOT SPRINGS AR
71901
US

V. Phone/Fax

Practice location:
  • Phone: 501-651-2000
  • Fax: 501-651-2391
Mailing address:
  • Phone: 501-262-1041
  • Fax: 501-651-2384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN L BODEMANN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 501-520-7731