Provider Demographics
NPI:1417980384
Name:HUGHES, JUAN MARTIN (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:MARTIN
Last Name:HUGHES
Suffix:
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 1:10704 SAINT ANTHONY CT
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72908-0788
Mailing Address - Country:US
Mailing Address - Phone:479-459-6671
Mailing Address - Fax:
Practice Address - Street 1:1301B S WALDRON RD
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-2555
Practice Address - Country:US
Practice Address - Phone:479-595-2437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE0287207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR129853001Medicaid
OK100078190AMedicaid
ARG17790Medicare UPIN
AR129853001Medicaid