Healthcare Provider Details

I. General information

NPI: 1770550543
Provider Name (Legal Business Name): STEPHEN HINGSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 01/25/2021
Certification Date: 01/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 ARNOLD DR
LITTLE ROCK AIR FORCE BASE AR
72099-4933
US

IV. Provider business mailing address

1090 ARNOLD DR
LITTLE ROCK AIR FORCE BASE AR
72099-4933
US

V. Phone/Fax

Practice location:
  • Phone: 501-987-7319
  • Fax:
Mailing address:
  • Phone: 501-987-7319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0101052587
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMED-PHYS-LIC-59745
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: