Healthcare Provider Details

I. General information

NPI: 1801869151
Provider Name (Legal Business Name): ROGERS FAMILY AND OCCUPATIONAL MEDICINE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615B WEST PERSIMMON
ROGERS AR
72756
US

IV. Provider business mailing address

1615B WEST PERSIMMON
ROGERS AR
72756
US

V. Phone/Fax

Practice location:
  • Phone: 479-636-7192
  • Fax: 479-621-9749
Mailing address:
  • Phone: 479-636-7192
  • Fax: 479-621-9749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY WAYNE YAWN
Title or Position: PRESIDENT
Credential: MD
Phone: 479-621-9749