Provider Demographics
NPI:1861406217
Name:HILDEBRAND, JAMES RUSSELL (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:RUSSELL
Last Name:HILDEBRAND
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2200 FORT ROOTS DR # 126
Mailing Address - Street 2:BLDG. 111, ROOM 24
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72114-1709
Mailing Address - Country:US
Mailing Address - Phone:501-257-2023
Mailing Address - Fax:501-257-2026
Practice Address - Street 1:2200 FORT ROOTS DR # 126
Practice Address - Street 2:BLDG. 111, ROOM 24
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-1709
Practice Address - Country:US
Practice Address - Phone:501-257-2023
Practice Address - Fax:501-257-2026
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
TXE9232208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARVAD000Medicare UPIN