Healthcare Provider Details

I. General information

NPI: 1265455596
Provider Name (Legal Business Name): ROBERT B ALLEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 03/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E JACKSON AVE
JONESBORO AR
72401-3119
US

IV. Provider business mailing address

225 E JACKSON AVE
JONESBORO AR
72401-3119
US

V. Phone/Fax

Practice location:
  • Phone: 870-207-5200
  • Fax:
Mailing address:
  • Phone: 870-207-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberC-6367
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number66638-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: