Provider Demographics
NPI:1003887217
Name:BREVING, ROBERT E JR (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:BREVING
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 MALVERN AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-7759
Mailing Address - Country:US
Mailing Address - Phone:501-623-9300
Mailing Address - Fax:501-623-9305
Practice Address - Street 1:1900 MALVERN AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-7759
Practice Address - Country:US
Practice Address - Phone:501-623-9300
Practice Address - Fax:501-623-9305
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR201408921208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5N045OtherBCBS
AR154398001Medicaid
AR5M986Medicare ID - Type Unspecified
CA5N045OtherBCBS
AR5M986C752Medicare PIN