Provider Demographics
NPI:1285602292
Name:ROBBINS, BRUCE DONALD (MD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:DONALD
Last Name:ROBBINS
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 1:1422 HWY 62 SW
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-4617
Mailing Address - Country:US
Mailing Address - Phone:870-424-6634
Mailing Address - Fax:870-424-6648
Practice Address - Street 1:1422 HWY 62 SW
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-4617
Practice Address - Country:US
Practice Address - Phone:870-424-6634
Practice Address - Fax:870-424-6648
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARN8229174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR130015521OtherMEDICARE RAILROAD
AR131368002Medicaid
AR13174000040OtherQUALCHOICE HEALTH PLAN
AR55483OtherBLUE CROSS BLUE SHIELD
AR55483OtherBLUE CROSS BLUE SHIELD
ARE51167Medicare UPIN