Provider Demographics
NPI:1063402519
Name:PENOR, STEPHEN PATRICK (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:PATRICK
Last Name:PENOR
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3633 CENTRAL AVENUE
Mailing Address - Street 2:SUITE D
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-6475
Mailing Address - Country:US
Mailing Address - Phone:501-623-6693
Mailing Address - Fax:501-623-9403
Practice Address - Street 1:3633 CENTRAL AVENUE
Practice Address - Street 2:SUITE D
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6475
Practice Address - Country:US
Practice Address - Phone:501-623-6693
Practice Address - Fax:501-623-9403
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE3410174400000X
ARE-34102085N0904X, 2085R0202X
TXV72742085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No174400000XOther Service ProvidersSpecialist
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARE3410OtherSTATE LICENSE
AR157515001Medicaid
ARE3410OtherSTATE LICENSE
AR5N162Medicare PIN
BP8068163OtherDEA LICENSE