Provider Demographics
NPI:1124081849
Name:HULL, CHERYL ANN (MD)
Entity type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:ANN
Last Name:HULL
Suffix:
Gender:F
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 52ND ST
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8600
Mailing Address - Country:US
Mailing Address - Phone:479-254-9662
Mailing Address - Fax:479-254-9652
Practice Address - Street 1:500 S 52ND ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8600
Practice Address - Country:US
Practice Address - Phone:479-254-9662
Practice Address - Fax:479-254-9652
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE3069207N00000X
ARBH7561409207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR158407001Medicaid
I08050Medicare UPIN
AR158407001Medicaid