Provider Demographics
NPI:1477757896
Name:ROY L PUEN
Entity type:Organization
Organization Name:ROY L PUEN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:L
Authorized Official - Last Name:PUEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-525-7800
Mailing Address - Street 1:295 SECTION LINE RD
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-6433
Mailing Address - Country:US
Mailing Address - Phone:501-525-7800
Mailing Address - Fax:501-525-6170
Practice Address - Street 1:295 SECTION LINE RD
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6433
Practice Address - Country:US
Practice Address - Phone:501-525-7800
Practice Address - Fax:501-525-6170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE0602261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR128102001Medicaid
ARF76696Medicare UPIN
AR128102001Medicaid