Provider Demographics
NPI:1598764896
Name:DORMAN, ROBERT ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ANTHONY
Last Name:DORMAN
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 1:2850 TWIN RIVERS DR
Mailing Address - Street 2:SUITE 101-A
Mailing Address - City:ARKADELPHIA
Mailing Address - State:AR
Mailing Address - Zip Code:71923-4212
Mailing Address - Country:US
Mailing Address - Phone:870-246-6766
Mailing Address - Fax:870-246-3860
Practice Address - Street 1:2850 TWIN RIVERS DR
Practice Address - Street 2:SUITE 101-A
Practice Address - City:ARKADELPHIA
Practice Address - State:AR
Practice Address - Zip Code:71923-4212
Practice Address - Country:US
Practice Address - Phone:870-246-6766
Practice Address - Fax:870-246-3860
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2009-11-09
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-23
Provider Licenses
StateLicense IDTaxonomies
ARC5783207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
51418OtherBCBS
AR105262001Medicaid
14478000000OtherQUALCHOICE
14478000000OtherQUALCHOICE
AR105262001Medicaid