Provider Demographics
NPI:1821108051
Name:HUGENTOBLER, MCKAY
Entity Type:Individual
Prefix:
First Name:MCKAY
Middle Name:
Last Name:HUGENTOBLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 RIDGEWAY STE D
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901
Mailing Address - Country:US
Mailing Address - Phone:501-627-0700
Mailing Address - Fax:501-627-0706
Practice Address - Street 1:106 RIDGEWAY STE D
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901
Practice Address - Country:US
Practice Address - Phone:501-627-0700
Practice Address - Fax:501-627-0706
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR187213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR142705717Medicaid
U83001Medicare UPIN
AR5W159Medicare ID - Type Unspecified