Healthcare Provider Details

I. General information

NPI: 1487061172
Provider Name (Legal Business Name): RONALD HUDSPETH COTA-L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2014
Last Update Date: 07/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 BALCOM LN
TRUMANN AR
72472-9502
US

IV. Provider business mailing address

1005 BALCOM LN
TRUMANN AR
72472-9502
US

V. Phone/Fax

Practice location:
  • Phone: 870-483-1461
  • Fax: 870-483-6520
Mailing address:
  • Phone: 870-483-1461
  • Fax: 870-483-6520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number02-A870
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: