Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | A126037 | CA |
Y | 2081P2900X | Pain Medicine | E-8744 | AR |
NPI | 1093942252 |
---|---|
Provider Name | Stephen Paulus |
First Address | Little Rock, AR 72204-1720 |
Second Address | Little Rock, AR 72204 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2009 |
Last Update Date | 11/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1093942252 | NPI (01) | AR |
204363001 | (05) | AR |