Provider Demographics
NPI:1942293428
Name:ARNOLD, ROBERT WENDALL (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:WENDALL
Last Name:ARNOLD
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 1:3500 LA TOUCHE ST STE 280
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4261
Mailing Address - Country:US
Mailing Address - Phone:907-561-1917
Mailing Address - Fax:
Practice Address - Street 1:542 W 2ND AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-2208
Practice Address - Country:US
Practice Address - Phone:907-276-1617
Practice Address - Fax:907-264-2687
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA2439207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD1250Medicaid
AK018WCKRKAMedicare ID - Type Unspecified
AKMD1250Medicaid