Provider Demographics
NPI:1740423839
Name:DORMAN, ROBERT BRYAN (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:BRYAN
Last Name:DORMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1101 S HORSEBARN RD
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8237
Mailing Address - Country:US
Mailing Address - Phone:479-271-9607
Mailing Address - Fax:479-271-2133
Practice Address - Street 1:115 MEDICAL CIR STE 107
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75751-9004
Practice Address - Country:US
Practice Address - Phone:903-675-5781
Practice Address - Fax:903-677-1008
Is Sole Proprietor?:No
Enumeration Date:2009-04-20
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-8173208600000X
TXS4461208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1740423839Medicaid
AR343364YS1PMedicare PIN