Healthcare Provider Details

I. General information

NPI: 1336140888
Provider Name (Legal Business Name): JON M ROBERT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 05/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1629 AIRPORT RD SUITE B
HOT SPRINGS AR
71913-7951
US

IV. Provider business mailing address

1629 AIRPORT RD SUITE B
HOT SPRINGS AR
71913-7951
US

V. Phone/Fax

Practice location:
  • Phone: 501-767-0075
  • Fax: 501-760-2739
Mailing address:
  • Phone: 501-767-0075
  • Fax: 501-760-2739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR2529
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: