Individual
DR. RONALD J MULLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3 E APPLEBY RD STE 401, FAYETTEVILLE, AR 72703-3163
(479) 404-2500
(479) 404-2501
Mailing address
3 E APPLEBY RD STE 401, FAYETTEVILLE, AR 72703-3163
(479) 404-2500
(479) 404-2501
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
C7126
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100077770A
—
OK
05
—
113060001
—
AR
01
—
12445000000
QUALCHOICE
AR
05
—
203560800
—
MO
01
—
247267
HEALTHLINK
AR
01
—
4347758
AETNA INDIVIDUAL #
AR
Enumeration date
07/27/2006
Last updated
06/06/2023
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