Provider Demographics
NPI:1689779845
Name:ROBERT ANTHONY DORMAN MD PA
Entity Type:Organization
Organization Name:ROBERT ANTHONY DORMAN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:DORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD ,PA
Authorized Official - Phone:870-246-6766
Mailing Address - Street 1:2850 TWIN RIVERS DR
Mailing Address - Street 2:
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 STE 101A
Practice Address - Street 2:
Practice Address - City:ARKADELPHIA
Practice Address - State:AR
Practice Address - Zip Code:71923-4226
Practice Address - Country:US
Practice Address - Phone:870-246-6766
Practice Address - Fax:870-246-3860
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROBERT ANTHONY DORMAN MD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-13
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-5783174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR51418OtherBLUECROSS AND BLUE SHIELD
AR56733Medicare PIN
ARD04497Medicare UPIN