Provider Demographics
NPI:1871570648
Name:VENABLE, ROBERT S (M D)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:VENABLE
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 S PROMENADE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-9073
Mailing Address - Country:US
Mailing Address - Phone:479-616-1485
Mailing Address - Fax:479-239-0536
Practice Address - Street 1:2012 S PROMENADE BLVD
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-9073
Practice Address - Country:US
Practice Address - Phone:479-616-1485
Practice Address - Fax:479-239-0536
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-077829207P00000X
FLME 65943207P00000X
AL16379207P00000X
CAC42512207P00000X, 207Q00000X
ARC5310207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL276256100Medicaid
IL036077829-2Medicaid
IL036077829Medicaid
IL036077829-4Medicaid
FL26887OtherBLUE SHIELD
CA1871570648Medicaid
IL036077829-1Medicaid
FL036077829Medicaid
IN200479270Medicaid
FL26887UMedicare PIN
IN200479270Medicaid
ILL99547Medicare PIN
FL26887OtherBLUE SHIELD
IL036077829-4Medicaid
FLC87705Medicare UPIN
FL276256100Medicaid
CABL882ZMedicare PIN