Provider Demographics
NPI:1134242191
Name:STEPHEN R. MAES, M.D., P.A.
Entity type:Organization
Organization Name:STEPHEN R. MAES, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:MAES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-741-8800
Mailing Address - Street 1:825 N SPRING ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-2942
Mailing Address - Country:US
Mailing Address - Phone:870-741-8800
Mailing Address - Fax:870-741-4545
Practice Address - Street 1:825 N SPRING ST
Practice Address - Street 2:SUITE F
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-2942
Practice Address - Country:US
Practice Address - Phone:870-741-8800
Practice Address - Fax:870-741-4545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC8283207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARMC-2241OtherCORP MEDICAL LICENSE
AR5F319Medicare ID - Type Unspecified