Healthcare Provider Details

I. General information

NPI: 1255457842
Provider Name (Legal Business Name): GUILFORD M. DUDLEY, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 MALCOLM AVE SUITE B
NEWPORT AR
72112-3668
US

IV. Provider business mailing address

2200 MALCOLM AVE SUITE B
NEWPORT AR
72112-3668
US

V. Phone/Fax

Practice location:
  • Phone: 870-512-2522
  • Fax: 870-512-2525
Mailing address:
  • Phone: 870-512-2522
  • Fax: 870-512-2525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License NumberR1908
License Number StateAR

VIII. Authorized Official

Name: GUILFORD M DUDLEY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 870-512-2522