Provider Demographics
NPI:1225450026
Name:HUTSON, SANFORD ELMER III (MD)
Entity Type:Individual
Prefix:DR
First Name:SANFORD
Middle Name:ELMER
Last Name:HUTSON
Suffix:III
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 1:506 FAIRWAY CIR
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-1027
Mailing Address - Country:US
Mailing Address - Phone:479-756-5010
Mailing Address - Fax:
Practice Address - Street 1:506 FAIRWAY CIR
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-1027
Practice Address - Country:US
Practice Address - Phone:479-756-5010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-13
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-4349207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine