Provider Demographics
NPI:1437251642
Name:PANG, ROBERT R (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:R
Last Name:PANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RUSTY
Other - Middle Name:
Other - Last Name:PANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5200 BUTTERFIELD COACH RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-8087
Mailing Address - Country:US
Mailing Address - Phone:479-756-9121
Mailing Address - Fax:
Practice Address - Street 1:130 E POPLAR ST STE A
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-2573
Practice Address - Country:US
Practice Address - Phone:479-442-2999
Practice Address - Fax:479-442-7491
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-62032084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARD04386Medicare UPIN
AR50612Medicare ID - Type Unspecified