Healthcare Provider Details

I. General information

NPI: 1447228663
Provider Name (Legal Business Name): RANDY D ROBERTS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 09/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 C EAST MATTHEWS
JONESBORO AR
72401
US

IV. Provider business mailing address

1000 C 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:
Title or Position:
Credential:
Phone: