Provider Demographics
NPI:1235281296
Name:PUEN, ROY L (MD)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:L
Last Name:PUEN
Suffix:
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 1:295 SECTION LINE ROAD
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913
Mailing Address - Country:US
Mailing Address - Phone:501-525-7800
Mailing Address - Fax:501-525-6170
Practice Address - Street 1:295 SECTION LINE ROAD
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913
Practice Address - Country:US
Practice Address - Phone:501-525-7800
Practice Address - Fax:501-525-7800
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE0602207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR130861002OtherMEDICAID CLINIC
AR128102001Medicaid
5J891Medicare ID - Type Unspecified
AR128102001Medicaid