Provider Demographics
NPI:1669435178
Name:ARCHULETA, BOBBY ARNOLD (MD)
Entity type:Individual
Prefix:
First Name:BOBBY
Middle Name:ARNOLD
Last Name:ARCHULETA
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 1:1001 HIOAKS RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-4029
Mailing Address - Country:US
Mailing Address - Phone:804-320-7139
Mailing Address - Fax:804-323-0153
Practice Address - Street 1:1001 HIOAKS RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-4029
Practice Address - Country:US
Practice Address - Phone:804-320-7139
Practice Address - Fax:804-323-0153
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA29895174400000X
VA0101029895208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006707882Medicaid