Provider Demographics
NPI:1447339544
Name:TAYLOR, ROBERT (MD, FACS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3733 N BUSINESS DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-5203
Mailing Address - Country:US
Mailing Address - Phone:479-521-1500
Mailing Address - Fax:479-521-5413
Practice Address - Street 1:3733 N BUSINESS DR
Practice Address - Street 2:SUITE 102
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5203
Practice Address - Country:US
Practice Address - Phone:479-521-1500
Practice Address - Fax:479-521-5413
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2086S0122X208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR120609001Medicaid
AR5AH19G725Medicare PIN