Provider Demographics
NPI:1659608669
Name:RICHARD E. BRALEY, M.D. P.A.
Entity Type:Organization
Organization Name:RICHARD E. BRALEY, M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:BRALEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-525-0790
Mailing Address - Street 1:1661 HIGDON FERRY RD
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS NATIONAL PARK
Mailing Address - State:AR
Mailing Address - Zip Code:71913-6913
Mailing Address - Country:US
Mailing Address - Phone:501-525-0790
Mailing Address - Fax:501-525-9989
Practice Address - Street 1:1661 HIGDON FERRY RD
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS NATIONAL PARK
Practice Address - State:AR
Practice Address - Zip Code:71913-6913
Practice Address - Country:US
Practice Address - Phone:501-525-0790
Practice Address - Fax:501-525-9989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-11
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR2711207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1314100040OtherQUALCHOICE
AR102433001Medicaid
AR1314100040OtherQUALCHOICE
D84080Medicare UPIN