Basic Information
| Provider Information | |||||||||
| NPI: | 1548377849 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FORWARD | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | B. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 648 SHARP AVE | ||||||||
| Address2: | |||||||||
| City: | CAMDEN | ||||||||
| State: | AR | ||||||||
| PostalCode: | 717012628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8708362467 | ||||||||
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| Practice Location | |||||||||
| Address1: | 500 S UNIVERSITY AVE STE 600 | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722055324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016862688 | ||||||||
| FaxNumber: | 5016640302 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2006 | ||||||||
| LastUpdateDate: | 10/05/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | R3836 | AR | N | Other Service Providers | Specialist | 208D00000X | R3836 | AR | Y | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 710813069 | 01 | AR | FED. TAX ID# | OTHER | 116800001 | 05 | AR | MEDICAID | R3836 | 01 | AR | ST. MED. LICENSE # | OTHER | 5C070 | 01 | AR | GRP.'S MCARE PROV. # | OTHER |