Provider Demographics
NPI:1992740393
Name:HUDEFI, FAYZ A (MD)
Entity type:Individual
Prefix:DR
First Name:FAYZ
Middle Name:A
Last Name:HUDEFI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11001 EXECUTIVE CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4393
Mailing Address - Country:US
Mailing Address - Phone:479-441-5601
Mailing Address - Fax:479-521-6520
Practice Address - Street 1:1001 TOWSON AVE FL 6
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-4921
Practice Address - Country:US
Practice Address - Phone:479-441-5601
Practice Address - Fax:479-709-7423
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE47732084P0800X
ARE-47732084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR06070018900OtherQUALCHOICE
AR5N608OtherBLUE CROSS
AR162087001Medicaid
OK200088300AMedicaid
AR000181515OtherUNITED BEHAVIORAL HLTH
ARI 59528Medicare UPIN
AR162087001Medicaid