Provider Demographics
NPI:1770525594
Name:HANEY, RONDALL KEVIN (MD)
Entity type:Individual
Prefix:DR
First Name:RONDALL
Middle Name:KEVIN
Last Name:HANEY
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 1:5433 W WALSH LN
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8946
Mailing Address - Country:US
Mailing Address - Phone:479-464-8346
Mailing Address - Fax:479-464-9046
Practice Address - Street 1:5433 WALSH LANE
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758
Practice Address - Country:US
Practice Address - Phone:479-464-8346
Practice Address - Fax:479-464-9046
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-8120202K00000X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No202K00000XAllopathic & Osteopathic PhysiciansPhlebology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARP00255263OtherRR MCR
AR127110001Medicaid
AR5J657OtherAR BC/BS
OK200060590AMedicaid
OK200060590AMedicaid
AR5J657C912Medicare PIN
ARP00255263OtherRR MCR