Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 201408921 | AR |
Y | 208600000X | Surgeon | 201408921 | AR |
N | 2086S0129X | Vascular Surgeon | 201408921 | AR |
NPI | 1003887217 |
---|---|
Provider Name | Robert E Breving JR. |
First Address | Hot Springs, AR 71901-7759 |
Second Address | Hot Springs, AR 71901-7759 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2006 |
Last Update Date | 08/12/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
154398001 | (05) | AR |
5N045 | BCBS (01) | CA |
G40491 | (02) | AR |