Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | E3586 | AR |
NPI | 1043273568 |
---|---|
Provider Name | Dr. Mario Cauli |
First Address | Jonesboro, AR 72401-4315 |
Second Address | Jonesboro, AR 72401-4315 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2006 |
Last Update Date | 23/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
143512002 | (05) | AR |
149117001 | (05) | AR |
H75990 | (02) | AR |