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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