Individual
JONATHAN C. ROBERTSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
114 RAY ST, NEWPORT, AR 72112-4260
(870) 523-2944
(870) 523-2998
Mailing address
PO BOX 497, AUGUSTA, AR 72006-0497
(870) 347-2534
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
E-2356
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
138481001
—
AR
01
—
5L325
BCBS
AR
01
—
P00780865
RAILROAD MCARE THRU WMCM
AR
Enumeration date
12/15/2005
Last updated
03/01/2022
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