Provider Demographics
NPI:1124178355
Name:TROVILLION, ROBERT B (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:B
Last Name:TROVILLION
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2783 N CENTERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-3604
Mailing Address - Country:US
Mailing Address - Phone:479-251-1697
Mailing Address - Fax:479-251-1691
Practice Address - Street 1:350 E MILLSAP RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4098
Practice Address - Country:US
Practice Address - Phone:479-521-7850
Practice Address - Fax:479-442-4779
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR174213E00000X
MO000805213E00000X
WI768213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1300660001OtherDME SUPPLIER NUMBER
1300660001OtherDME SUPPLIER NUMBER
AR5U017Medicare ID - Type Unspecified