Provider Demographics
NPI:1255394466
Name:HILL, EDWARD BIBB III (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:BIBB
Last Name:HILL
Suffix:III
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 1:6701 HIGHWAY 67
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015-8909
Mailing Address - Country:US
Mailing Address - Phone:501-860-0500
Mailing Address - Fax:501-860-0749
Practice Address - Street 1:112 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-3765
Practice Address - Country:US
Practice Address - Phone:501-778-5740
Practice Address - Fax:501-778-5743
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-5655207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR105501001Medicaid
D84147Medicare UPIN