Provider Demographics
NPI:1760426043
Name:MEEHAN, RALPH EDWIN II (DO)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:EDWIN
Last Name:MEEHAN
Suffix:II
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 1:1101 PROGRESS AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-4343
Mailing Address - Country:US
Mailing Address - Phone:479-549-4010
Mailing Address - Fax:479-549-3302
Practice Address - Street 1:3721 HIGHWAY 412 E STE A
Practice Address - Street 2:
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761-8010
Practice Address - Country:US
Practice Address - Phone:479-215-3035
Practice Address - Fax:479-524-1818
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE1104207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100181270AMedicaid
AR134149003Medicaid
5K421Medicare ID - Type Unspecified
AR134149003Medicaid