1235244914 NPI number — STEPHEN RAULS, MD PLLC, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235244914 NPI number — STEPHEN RAULS, MD PLLC, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEPHEN RAULS, MD PLLC, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235244914
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
505 E MATTHEWS AVE STE 203
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JONESBORO
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72401-3101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-268-9727
Provider Business Mailing Address Fax Number:
870-268-9744

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
505 E MATTHEWS AVE STE 203
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JONESBORO
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72401-3101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-268-9727
Provider Business Practice Location Address Fax Number:
870-268-9744
Provider Enumeration Date:
08/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SPEAKMAN
Authorized Official First Name:
MARSHA
Authorized Official Middle Name:
SUE
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
870-268-9727

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  C5444 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 103519001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".