Provider Demographics
NPI:1760820575
Name:HEMMINGS, STEFAN CERU (MB, BS)
Entity Type:Individual
Prefix:DR
First Name:STEFAN
Middle Name:CERU
Last Name:HEMMINGS
Suffix:
Gender:M
Credentials:MB, BS
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 17930
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72222-7930
Mailing Address - Country:US
Mailing Address - Phone:501-663-0490
Mailing Address - Fax:501-663-5948
Practice Address - Street 1:3401 SPRINGHILL DR STE 325
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117
Practice Address - Country:US
Practice Address - Phone:501-955-0320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-13
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-10971207RN0300X, 207RN0300X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR229303001Medicaid
AR664751OtherMEDICARE