Healthcare Provider Details

I. General information

NPI: 1649254228
Provider Name (Legal Business Name): JOHN W ROBINETTE DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 10/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 W 40TH AVE SUITE 6B
PINE BLUFF AR
71603-6900
US

IV. Provider business mailing address

1801 W 40TH AVE SUITE 6B
PINE BLUFF AR
71603-6900
US

V. Phone/Fax

Practice location:
  • Phone: 870-534-8500
  • Fax: 870-535-0801
Mailing address:
  • Phone: 870-534-8500
  • Fax: 870-535-0801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number165
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number165
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: