Healthcare Provider Details

I. General information

NPI: 1891018958
Provider Name (Legal Business Name): BENTON COUNTY UROLOGY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2010
Last Update Date: 09/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S 20TH ST STE C
ROGERS AR
72758-1100
US

IV. Provider business mailing address

200 S 20TH ST STE C
ROGERS AR
72758-1100
US

V. Phone/Fax

Practice location:
  • Phone: 479-636-9669
  • Fax: 479-636-0743
Mailing address:
  • Phone: 479-636-9669
  • Fax: 479-636-0743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberE-4951
License Number StateAR

VIII. Authorized Official

Name: DR. ROBERT ALLEN ZIMMERMAN
Title or Position: PRESIDENT/OWNER/PHYSICAN
Credential: MD, PHD
Phone: 479-636-9669