Healthcare Provider Details

I. General information

NPI: 1801869185
Provider Name (Legal Business Name): TIMOTHY WAYNE YAWN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 10/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615W PERSIMMON ST B
ROGERS AR
72756-3383
US

IV. Provider business mailing address

1615 W PERSIMMON ST
ROGERS AR
72756-3383
US

V. Phone/Fax

Practice location:
  • Phone: 479-636-7192
  • Fax: 479-631-8212
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 NumberC7558
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: