Provider Demographics
NPI:1558385260
Name:HUDEC, REGINA R (MD)
Entity Type:Individual
Prefix:DR
First Name:REGINA
Middle Name:R
Last Name:HUDEC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:GINA
Other - Middle Name:ROSA
Other - Last Name:HUDEC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3017 N BOB YOUNKIN DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-3926
Mailing Address - Country:US
Mailing Address - Phone:479-521-1484
Mailing Address - Fax:479-521-1550
Practice Address - Street 1:3017 N BOB YOUNKIN DR
Practice Address - Street 2:SUITE 101
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-3926
Practice Address - Country:US
Practice Address - Phone:479-521-1484
Practice Address - Fax:479-521-1550
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARN8290208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1652645001OtherQUALCHOICE
AR130868001Medicaid
OK200062630AMedicaid
AR130868001Medicaid
OK200062630AMedicaid