Provider Demographics
NPI:1851301493
Name:HEGWOOD, HENRY MELVIN (MD)
Entity Type:Individual
Prefix:MR
First Name:HENRY
Middle Name:MELVIN
Last Name:HEGWOOD
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 21325
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71903-1325
Mailing Address - Country:US
Mailing Address - Phone:501-525-3286
Mailing Address - Fax:
Practice Address - Street 1:1801 W 40TH AVE
Practice Address - Street 2:SUITE 2C
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-6940
Practice Address - Country:US
Practice Address - Phone:870-534-8651
Practice Address - Fax:870-534-2827
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR22782085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR52301Medicare ID - Type Unspecified
ARC68479Medicare UPIN