Basic Information
| Provider Information | |||||||||
| NPI: | 1881623965 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HEDBERG | ||||||||
| FirstName: | CURTIS | ||||||||
| MiddleName: | LARS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 S 52ND ST | ||||||||
| Address2: | |||||||||
| City: | ROGERS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72758 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4794648887 | ||||||||
| FaxNumber: | 4794649949 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 S 52ND ST | ||||||||
| Address2: | |||||||||
| City: | ROGERS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72758 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4794648887 | ||||||||
| FaxNumber: | 4794649949 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2006 | ||||||||
| LastUpdateDate: | 07/13/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207K00000X | N-8013 | AR | Y | Allopathic & Osteopathic Physicians | Allergy & Immunology |
ID Information
| ID | Type | State | Issuer | Description | 117979001 | 05 | AR | PERSONAL MEDICAID NUMBER | MEDICAID | 54220 | 01 | AR | BLUE CROSS BLUE SHIELD | OTHER |