Healthcare Provider Details

I. General information

NPI: 1205943289
Provider Name (Legal Business Name): JOE P ROUSE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1306 S PLEASANT ST
SPRINGDALE AR
72764-6223
US

IV. Provider business mailing address

1306 S PLEASANT ST
SPRINGDALE AR
72764-6223
US

V. Phone/Fax

Practice location:
  • Phone: 479-443-0500
  • Fax: 833-449-3362
Mailing address:
  • Phone: 479-443-0500
  • Fax: 833-449-3362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC4405
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: