Individual
DR. RONDALL KEVIN HANEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5433 WALSH LANE, ROGERS, AR 72758
(479) 464-8346
(479) 464-9046
Mailing address
5433 W WALSH LN, ROGERS, AR 72758-8946
(479) 464-8346
(479) 464-9046
Taxonomy
Speciality
Code
Description
License number
State
202K00000X
Phlebology Physician
C-8120
AR
2085R0202X
Diagnostic Radiology Physician
Primary
C-8120
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
127110001
—
AR
05
—
200060590A
—
OK
01
—
5J657
AR BC/BS
AR
01
—
P00255263
RR MCR
AR
Enumeration date
06/13/2006
Last updated
09/15/2020
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