=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245268879
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FERNANDO PADILLA M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2006
-----------------------------------------------------
Last Update Date | 01/14/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 S UNIVERSITY AVE SUITE 811
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72205-5302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-661-1822
-----------------------------------------------------
Fax | 501-666-0266
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 500 S UNIVERSITY AVE SUITE 811
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72205-5302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-661-1822
-----------------------------------------------------
Fax | 501-666-0266
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RH0003X
-----------------------------------------------------
Taxonomy Name | Hematology & Oncology Physician
-----------------------------------------------------
License Number | C4351
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------