Provider Demographics
NPI:1902867070
Name:NOONAN, ROBERT F (MD)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:F
Last Name:NOONAN
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 1:25 PROFESSIONAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72830-4432
Mailing Address - Country:US
Mailing Address - Phone:479-705-8181
Mailing Address - Fax:479-705-0041
Practice Address - Street 1:25 PROFESSIONAL PARK DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72830-4432
Practice Address - Country:US
Practice Address - Phone:479-705-8181
Practice Address - Fax:479-705-0041
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE0762207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR129815001Medicaid
AR5K019OtherARK BLUECROSS
AR129815001Medicaid
AR5K019Medicare ID - Type Unspecified