Provider Demographics
NPI:1407082464
Name:HULL DERMATOLOGY P.A.
Entity Type:Organization
Organization Name:HULL DERMATOLOGY P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:A
Authorized Official - Last Name:HULL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-254-9662
Mailing Address - Street 1:500 S 52ND ST
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8600
Mailing Address - Country:US
Mailing Address - Phone:479-254-9662
Mailing Address - Fax:479-254-9652
Practice Address - Street 1:500 S 52ND ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8600
Practice Address - Country:US
Practice Address - Phone:479-254-9662
Practice Address - Fax:479-254-9652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-04
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE3069261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty