Healthcare Provider Details

I. General information

NPI: 1467549972
Provider Name (Legal Business Name): PAUL JAMES HUFFSTUTTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 SOUTH RHODES STREET
WEST MEMPHIS AR
72301
US

IV. Provider business mailing address

300 SOUTH RHODES STREET
WEST MEMPHIS AR
72301
US

V. Phone/Fax

Practice location:
  • Phone: 870-735-3664
  • Fax: 870-735-0449
Mailing address:
  • Phone: 870-735-3664
  • Fax: 870-735-0449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberR2875
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: