Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | R3271 | AR |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | R3271 | AR |
NPI | 1508858036 |
---|---|
Provider Name | Dr. Thomas S Roberts |
First Address | Conway, AR 72034-3681 |
Second Address | Conway, AR 72034 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2005 |
Last Update Date | 03/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
114409001 | (05) | AR |
114652002 | (05) | AR |
12592000000 | QUALCHOICE (01) | AR |
200011968 | RR MEDICARE (01) | AR |
51490 | BCBS (01) | AR |
B64469 | (02) | AR |