Healthcare Provider Details

I. General information

NPI: 1568175735
Provider Name (Legal Business Name): ROBIN RAY PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2023
Last Update Date: 01/03/2023
Certification Date: 01/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 W OAK ST STE 301
EL DORADO AR
71730-4575
US

IV. Provider business mailing address

403 W OAK ST STE 301
EL DORADO AR
71730-4575
US

V. Phone/Fax

Practice location:
  • Phone: 870-862-8221
  • Fax: 870-863-5682
Mailing address:
  • Phone: 870-862-8221
  • Fax: 870-863-5682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBIN P RAY
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 870-862-8221