# PAUL J. HERGENROEDER, M.D., LTD

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124171293
- **Authorized official:** DR. PAUL JOHN HERGENROEDER MD (PRESIDENT)
- **Authorized official phone:** (870) 523-6728

## Contact information

- **Practice address:** 2000 MCLAIN ST, NEWPORT, AR 72112-3661
- **Practice address phone:** (870) 523-6728
- **Mailing address:** PO BOX 39, NEWPORT, AR 72112-0039
- **Mailing address phone:** (870) 523-6728

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | N7174 | AR | Yes |

## Other

- **Enumeration date:** 01/19/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 5B232 | BLUECROSSBLUESHIELD | — |