Provider Demographics
NPI:1447251137
Name:FLOSS, ROBERT ALLEN (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALLEN
Last Name:FLOSS
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 1:402 N LEE ST
Mailing Address - Street 2:P.O. BOX 686
Mailing Address - City:HAMPTON
Mailing Address - State:AR
Mailing Address - Zip Code:71744-8937
Mailing Address - Country:US
Mailing Address - Phone:870-798-3490
Mailing Address - Fax:870-798-4288
Practice Address - Street 1:402 N LEE ST
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:AR
Practice Address - Zip Code:71744-0686
Practice Address - Country:US
Practice Address - Phone:870-798-3490
Practice Address - Fax:870-798-4288
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR-4001207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR116480001Medicaid
AR53279Medicare ID - Type Unspecified
ARE14871Medicare UPIN