Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 2010-00775 | NC |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | E6542 | AR |
NPI | 1356560692 |
---|---|
Provider Name | Russell B. Rauls |
First Address | Mountain Home, AR 72653-2918 |
Second Address | Mountain Home, AR 72653-2918 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2007 |
Last Update Date | 22/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
440106101 | (05) | AR |