Provider Demographics
NPI:1689728974
Name:CYRIL A RABEN MDPA
Entity Type:Organization
Organization Name:CYRIL A RABEN MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:RABEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-442-4495
Mailing Address - Street 1:350 E MILLSAP RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4098
Mailing Address - Country:US
Mailing Address - Phone:479-442-4495
Mailing Address - Fax:479-442-8178
Practice Address - Street 1:350 E MILLSAP RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4098
Practice Address - Country:US
Practice Address - Phone:479-442-4495
Practice Address - Fax:479-442-8178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARN7877174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5C794OtherBCBS
5C794Medicare PIN