Healthcare Provider Details

I. General information

NPI: 1114993060
Provider Name (Legal Business Name): LOUIS WOODROW ELKINS JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

628 HOSPITAL DR STE 1-A
MOUNTAIN HOME AR
72653-2946
US

IV. Provider business mailing address

PO BOX 958539
SAINT LOUIS MO
63195-8539
US

V. Phone/Fax

Practice location:
  • Phone: 870-508-3200
  • Fax: 870-508-1359
Mailing address:
  • Phone: 870-508-3200
  • Fax: 870-508-1359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number01084572A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberJ6104
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberC-7077
License Number StateAR
# 4
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberJ6104
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036155579
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number036155579
License Number StateIL
# 7
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number01084572A
License Number StateIN
# 8
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberJ6104
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: