Healthcare Provider Details

I. General information

NPI: 1407082464
Provider Name (Legal Business Name): HULL DERMATOLOGY P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2009
Last Update Date: 08/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S 52ND ST
ROGERS AR
72758-8600
US

IV. Provider business mailing address

500 S 52ND ST
ROGERS AR
72758-8600
US

V. Phone/Fax

Practice location:
  • Phone: 479-254-9662
  • Fax: 479-254-9652
Mailing address:
  • Phone: 479-254-9662
  • Fax: 479-254-9652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberE3069
License Number StateAR

VIII. Authorized Official

Name: DR. CHERYL A HULL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 479-254-9662