Provider Demographics
NPI:1336132372
Name:ROBERTS, KEVIN D (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:D
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:701 N UNIVERSITY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205
Mailing Address - Country:US
Mailing Address - Phone:501-224-1690
Mailing Address - Fax:501-224-1927
Practice Address - Street 1:701 N UNIVERSITY
Practice Address - Street 2:SUITE 100
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205
Practice Address - Country:US
Practice Address - Phone:501-664-4810
Practice Address - Fax:501-663-1256
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARC-7744207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR11127000000OtherQUAL CHOICE
AR01-20360OtherUNITED HEALTHCARE
AR11127000000OtherQUAL CHOICE
AR55287Medicare PIN