MEDICARE: KEITH A COWARD MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	E3154	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	03090020300	OTHER	AR	QUALCHOICE

General Provider Information

NPI Number	:	1710982871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEITH A COWARD MD

Provider Business Mailing Address
First Line	:	2526 HIGHWAY 65 S
Second Line	:	SUITE 201
City	:	CLINTON
State	:	AR
Zip	:	72031-6657
Country	:	US
Telephone Number	:	501-745-3388
Fax Number	:	501-745-3006

Provider Business Practice Location Address
First Line	:	2526 HIGHWAY 65 S
Second Line	:	SUITE 201
City	:	CLINTON
State	:	AR
Zip	:	72031-6657
Country	:	US
Telephone Number	:	501-745-3388
Fax Number	:	501-745-3006

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	11/03/2011

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Directions to “ KEITH A COWARD MD” Practice Location

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