Individual provider Active NPI

Alan F Udouj, MD

  • Diagnostic Radiology Physician
  • Fayetteville, AR
National Provider Identifier
1730202417
Registry record updated Aug 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
E-6468 Issued in AR
Practice address
3344 N Futrall Dr
Fayetteville, AR 72703
Phone
(479) 443-5316
Fax
(479) 582-7389
NPI assigned
Apr 9, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X E-6468 AR Primary

Addresses

Primary practice location

3344 N Futrall Dr
Fayetteville, AR 72703

Mailing address

PO Box 1523
Fayetteville, AR 72702-1523
Phone (479) 571-6038

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190109002737 AR Practitioner - Diagnostic Radiology 4688910839 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of Arkansas College of Medicine, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3344 N Futrall Dr
Fayetteville, AR 72703-4057
Phone (479) 521-8200

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Associates of Northwest Arkansas PA CurrentSince Feb 1, 2019 Accepting new patients
Medical Associates of Northwest Arkansas, PA Diagnostic Radiology Current Accepting new patients
Medical Associates of Northwest Arkansas PA CurrentSince Feb 1, 2019 Accepting new patients
Medical Associates of Northwest Arkansas PA Past Accepting new patients
Medical Associates of Northwest Arkansas PA Diagnostic Radiology Past Accepting new patients

Locations

3383 N Mana Ct
Ste 102
Fayetteville, AR 72703
Phone (479) 571-6565

3344 N Futrall Dr
Fayetteville, AR 72703
Phone (479) 582-7213

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176076800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724025600000",
    "number": "1730202417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1523",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727021523",
            "telephone_number": "479-571-6038",
            "fax_number": "479-582-0222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3344 N FUTRALL DR",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "72703",
            "telephone_number": "479-443-5316",
            "fax_number": "479-582-7389"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UDOUJ",
        "first_name": "ALAN",
        "middle_name": "F",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-09",
        "last_updated": "2024-08-19",
        "certification_date": "2024-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "AR",
            "license": "E-6468",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, AR

Sources for this page

Verify at the official NPI Registry.