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Organization
PAUL J. HERGENROEDER, M.D., LTD
Active
Organization
PAUL J. HERGENROEDER, M.D., LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAUL JOHN HERGENROEDER MD (PRESIDENT)
(870) 523-6728
Entity
Organization
Contact information
Practice address
2000 MCLAIN ST, NEWPORT, AR 72112-3661
(870) 523-6728
Mailing address
PO BOX 39, NEWPORT, AR 72112-0039
(870) 523-6728
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
N7174
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5B232
BLUECROSSBLUESHIELD
—
Enumeration date
01/19/2007
Last updated
08/22/2020
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