MEDICARE: ROBERT S MCDONALD R MR

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	247100000X	Radiologic Technologist	RT1380	AR
2	2471M1202X	Magnetic Resonance Imaging Radiologic Technologist	290764

General Provider Information

NPI Number	:	1568586196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT S MCDONALD R MR

Provider Business Mailing Address
First Line	:	13529 COLONEL GLENN RD
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72210-2326
Country	:	US
Telephone Number	:	501-223-0102
Fax Number	:

Provider Business Practice Location Address
First Line	:	2019 E RACE AVE
Second Line	:
City	:	SEARCY
State	:	AR
Zip	:	72143-4725
Country	:	US
Telephone Number	:	501-223-0102
Fax Number	:

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

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	09/11/2025

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