Healthcare Provider Details

I. General information

NPI: 1619594256
Provider Name (Legal Business Name): CHRIS D ROHR HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2020
Last Update Date: 06/30/2020
Certification Date: 06/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 N MAIN ST STE B
HARRISON AR
72601-2924
US

IV. Provider business mailing address

1415 W HIGHWAY 50
O FALLON IL
62269-1618
US

V. Phone/Fax

Practice location:
  • Phone: 870-741-2774
  • Fax:
Mailing address:
  • Phone: 618-624-4471
  • Fax: 618-624-4496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number621
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: