Healthcare Provider Details

I. General information

NPI: 1609862838
Provider Name (Legal Business Name): ROGER D SCOW JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 12/27/2022
Certification Date: 12/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 W MAIN ST
MAGNOLIA AR
71753-3412
US

IV. Provider business mailing address

712 W MAIN ST
MAGNOLIA AR
71753-3412
US

V. Phone/Fax

Practice location:
  • Phone: 796-524-6304
  • Fax:
Mailing address:
  • Phone: 796-524-6304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberE5489
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: