Healthcare Provider Details

I. General information

NPI: 1245208503
Provider Name (Legal Business Name): RANDY D ROBERTS MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 09/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000C EAST MATTHEWS
JONESBORO AR
72401
US

IV. Provider business mailing address

1000C EAST MATTHEWS
JONESBORO AR
72401
US

V. Phone/Fax

Practice location:
  • Phone: 870-268-8880
  • Fax: 870-268-8882
Mailing address:
  • Phone: 870-268-8880
  • Fax: 870-268-8882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberN6752
License Number StateAR

VIII. Authorized Official

Name: RANDY D ROBERTS
Title or Position: MD
Credential: MD
Phone: 870-268-8880