MEDICARE: DR. ROBERTA ANN MONSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	C5258	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C5258	OTHER	AR	LICENSE NUMBER

General Provider Information

NPI Number	:	1477532844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERTA ANN MONSON M.D.

Provider Business Mailing Address
First Line	:	47 GLOUCESTER DR
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72227-2117
Country	:	US
Telephone Number	:	501-224-2656
Fax Number	:	501-224-2656

Provider Business Practice Location Address
First Line	:	47 GLOUCESTER DR
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72227-2117
Country	:	US
Telephone Number	:	501-224-2656
Fax Number	:	501-224-2656

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2006
Last Update Date	:	03/21/2008

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