Provider Demographics
NPI:1639107089
Name:MAUL, ROBERT V JR (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:V
Last Name:MAUL
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-3629
Mailing Address - Country:US
Mailing Address - Phone:479-524-4141
Mailing Address - Fax:479-549-2674
Practice Address - Street 1:205 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761-3629
Practice Address - Country:US
Practice Address - Phone:479-524-4141
Practice Address - Fax:479-549-2576
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARN6725207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1639107089Medicaid
OK100088720AMedicaid
AR108329003Medicaid
AR108329003Medicaid
MO1639107089Medicaid