Basic Information
| Provider Information | |||||||||
| NPI: | 1841277589 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MULDOON | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | T | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 133 HARMONY PARK | ||||||||
| Address2: | |||||||||
| City: | HOT SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719135417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016247700 | ||||||||
| FaxNumber: | 5016235788 | ||||||||
| Practice Location | |||||||||
| Address1: | 133 HARMONY PARK | ||||||||
| Address2: | |||||||||
| City: | HOT SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719135417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016247700 | ||||||||
| FaxNumber: | 5016235788 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/23/2005 | ||||||||
| LastUpdateDate: | 01/21/2010 | ||||||||
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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 | 207RH0003X | E-2766 | AR | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | P00012677 | 01 | RAILROAD MEDICARE | OTHER | 150344001 | 05 | AR | MEDICAID |