Provider Demographics
NPI:1063410140
Name:HYMAN, RALPH ALLEN (EDD)
Entity type:Individual
Prefix:DR
First Name:RALPH
Middle Name:ALLEN
Last Name:HYMAN
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 S PULASKI ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72201-1926
Mailing Address - Country:US
Mailing Address - Phone:501-374-3605
Mailing Address - Fax:501-374-3852
Practice Address - Street 1:210 S PULASKI ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72201-1926
Practice Address - Country:US
Practice Address - Phone:501-374-3605
Practice Address - Fax:501-374-3852
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR80-9P103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR50097000000OtherQUALCHOICE ID NUMBER
AR56226OtherBLUE CROSS ID NUMBER
AR11695744Medicaid