Healthcare Provider Details

I. General information

NPI: 1407858905
Provider Name (Legal Business Name): ROBERT G HORNBECK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 06/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2816 FOX MEADOW LN
JONESBORO AR
72404
US

IV. Provider business mailing address

PO BOX 497
AUGUSTA AR
72006-0497
US

V. Phone/Fax

Practice location:
  • Phone: 870-336-1676
  • Fax: 870-336-1679
Mailing address:
  • Phone: 870-347-2534
  • Fax: 870-347-3492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberE-1417
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: