Healthcare Provider Details

I. General information

NPI: 1922066232
Provider Name (Legal Business Name): ROBERT G WOOTEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 RIKE DRIVE
PINE BLUFF AR
71603
US

IV. Provider business mailing address

2500 RIKE DRIVE
PINE BLUFF AR
71603
US

V. Phone/Fax

Practice location:
  • Phone: 870-534-1834
  • Fax: 870-534-5798
Mailing address:
  • Phone: 870-534-1834
  • Fax: 870-534-5798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number#2373
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: