Healthcare Provider Details

I. General information

NPI: 1497376453
Provider Name (Legal Business Name): ROSS LENZEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2020
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 N BROADVIEW ST
GREENBRIER AR
72058-9475
US

IV. Provider business mailing address

PO BOX 9662
CONWAY AR
72033-9662
US

V. Phone/Fax

Practice location:
  • Phone: 501-679-3551
  • Fax: 501-679-4536
Mailing address:
  • Phone: 501-852-1363
  • Fax: 501-852-1364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE15200
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: