Healthcare Provider Details

I. General information

NPI: 1649632886
Provider Name (Legal Business Name): CESAR HURTADO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2016
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2877 W WALNUT ST STE 103
ROGERS AR
72756-0336
US

IV. Provider business mailing address

2877 W WALNUT ST STE 103
ROGERS AR
72756-0336
US

V. Phone/Fax

Practice location:
  • Phone: 479-372-4030
  • Fax: 479-372-4031
Mailing address:
  • Phone: 479-372-4030
  • Fax: 479-372-4031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberE-11309
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE-11309
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: