Provider Demographics
NPI:1457468498
Name:CEDENO, PHILIP A (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:A
Last Name:CEDENO
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 1:2900 MEDICAL CENTER PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-3214
Mailing Address - Country:US
Mailing Address - Phone:479-553-2250
Mailing Address - Fax:479-553-2260
Practice Address - Street 1:2900 MEDICAL CENTER PKWY STE 300
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-3214
Practice Address - Country:US
Practice Address - Phone:479-553-2250
Practice Address - Fax:479-553-2261
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-7736208600000X
KS0421713208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100125180CMedicaid
KSE84719Medicare UPIN
AR257027YKJLMedicare PIN
KS100125180CMedicaid