Provider Demographics
NPI:1477984979
Name:ROBERT R. HULL, M.D., P.A.
Entity Type:Organization
Organization Name:ROBERT R. HULL, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:NICHOLE
Authorized Official - Last Name:SEALS
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:479-636-0171
Mailing Address - Street 1:1301 W PERSIMMON ST
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-3345
Mailing Address - Country:US
Mailing Address - Phone:479-636-0171
Mailing Address - Fax:
Practice Address - Street 1:1301 W PERSIMMON ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-3345
Practice Address - Country:US
Practice Address - Phone:479-636-0171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-09
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR2036261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR101086001Medicaid
C68553Medicare UPIN