Provider Demographics
NPI:1245268879
Name:PADILLA, FERNANDO (MD)
Entity type:Individual
Prefix:
First Name:FERNANDO
Middle Name:
Last Name:PADILLA
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 1:500 S UNIVERSITY AVE
Mailing Address - Street 2:SUITE 811
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5302
Mailing Address - Country:US
Mailing Address - Phone:501-661-1822
Mailing Address - Fax:501-666-0266
Practice Address - Street 1:500 S UNIVERSITY AVE
Practice Address - Street 2:SUITE 811
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5302
Practice Address - Country:US
Practice Address - Phone:501-661-1822
Practice Address - Fax:501-666-0266
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC4351207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR104408001Medicaid
710779617PADOtherMERCY HEALTH PLANS
AS0500592OtherTRICARE
AR15162000000OtherQUAL-CHOICE OF ARKANSAS
830002634OtherRAILROAD MEDICARE
710779617OtherUNITED HEALTHCARE
341898OtherHEALTHLINK PPO
D17030Medicare UPIN
AR104408001Medicaid