Provider Demographics
NPI:1336140888
Name:ROBERT, JON M (MD)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:M
Last Name:ROBERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1629 AIRPORT RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-7951
Mailing Address - Country:US
Mailing Address - Phone:501-767-0075
Mailing Address - Fax:501-760-2739
Practice Address - Street 1:1629 AIRPORT RD
Practice Address - Street 2:SUITE B
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-7951
Practice Address - Country:US
Practice Address - Phone:501-767-0075
Practice Address - Fax:501-760-2739
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARR2529208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR102385001Medicaid
AR102385001Medicaid