Provider Demographics
NPI:1932191814
Name:HUDSON, STEPHEN A (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:A
Last Name:HUDSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3317 N WIMBERLY DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4056
Mailing Address - Country:US
Mailing Address - Phone:479-521-2752
Mailing Address - Fax:479-521-4603
Practice Address - Street 1:601 W MAPLE AVE STE 411
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-5374
Practice Address - Country:US
Practice Address - Phone:479-757-5354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR5L276207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR137305001Medicaid
AR0465700001Medicare NSC
ARG97756Medicare UPIN