Provider Demographics
NPI:1568586196
Name:MCDONALD, ROBERT S (R MR)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:R MR
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13529 COLONEL GLENN RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72210-2326
Mailing Address - Country:US
Mailing Address - Phone:501-223-0102
Mailing Address - Fax:
Practice Address - Street 1:2019 E RACE AVE
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4725
Practice Address - Country:US
Practice Address - Phone:501-223-0102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARRT1380247100000X
2907642471M1202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist
Not Answered2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance Imaging