Provider Demographics
NPI:1427373067
Name:REYENGA, WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:REYENGA
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 1:3633 CENTRAL AVE
Mailing Address - Street 2:STE D
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-6404
Mailing Address - Country:US
Mailing Address - Phone:501-623-6693
Mailing Address - Fax:501-623-9403
Practice Address - Street 1:3633 CENTRAL AVE
Practice Address - Street 2:STE D
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6404
Practice Address - Country:US
Practice Address - Phone:501-623-6693
Practice Address - Fax:501-623-9403
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-06
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ARE-91562085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR216229001Medicaid
AR216229001Medicaid