Provider Demographics
NPI:1619927241
Name:HUGHES, SAMUEL L (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:L
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:PO BOX 2009
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72811-2009
Mailing Address - Country:US
Mailing Address - Phone:479-964-9119
Mailing Address - Fax:
Practice Address - Street 1:1808 W MAIN ST
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801
Practice Address - Country:US
Practice Address - Phone:479-964-9119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA765832085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1849627 0004Medicaid
950494OtherPENNSYLVANIA BLUE SHIELD
P00067988OtherRR MEDICARE
NJ0014869Medicaid
010005690OtherAMERICHOICE
30035096OtherKEYSTONE MERCY
NJ3371019OtherAETNA
42278OtherUNIVERSITY HEALTHPLAN
60000607OtherHORIZON NJ HEALTH
PA1249860OtherAETNA
1863592OtherINDEPENDENCE BC PABS
2721771000OtherKEYSTONE IBC
NJP3003991OtherOXFORD
0871205000OtherAMERIHEALTH, KEYSTONE, IBC
6168488OtherCIGNA
2521909OtherUNITED HEALTHCARE
P00067988OtherRR MEDICARE
6168488OtherCIGNA
2521909OtherUNITED HEALTHCARE