Provider Demographics
NPI:1467487751
Name:ROOK, ROBERT BURL (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BURL
Last Name:ROOK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-5332
Mailing Address - Country:US
Mailing Address - Phone:501-329-2946
Mailing Address - Fax:501-329-2443
Practice Address - Street 1:919 LOCUST ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-5332
Practice Address - Country:US
Practice Address - Phone:501-329-2946
Practice Address - Fax:501-329-2443
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC6143207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR110443001Medicaid
AR54542Medicare ID - Type Unspecified
AR110443001Medicaid