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General NPI Number Information
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NPI Number | 1740423839
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Entity Type | Individual
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Provider Name | ROBERT BRYAN DORMAN MD
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Gender | Male
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Dates
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Enumeration Date | 04/20/2009
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Last Update Date | 07/22/2020
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Provider Practice Location Address
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Address Line | 115 MEDICAL CIR STE 107
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City | ATHENS
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State | TX
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Zip | 75751-9004
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Country | US
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Telephone | 903-675-5781
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Fax | 903-677-1008
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Provider Business Mailing Address
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Address Line | 1101 S HORSEBARN RD
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City | ROGERS
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State | AR
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Zip | 72758-8237
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Country | US
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Telephone | 479-271-9607
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Fax | 479-271-2133
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | E-8173
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | S4461
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License Number State | TX
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