=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710982871
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KEITH A COWARD MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2005
-----------------------------------------------------
Last Update Date | 11/03/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2526 HIGHWAY 65 S SUITE 201
-----------------------------------------------------
City | CLINTON
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72031-6657
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-745-3388
-----------------------------------------------------
Fax | 501-745-3006
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2526 HIGHWAY 65 S SUITE 201
-----------------------------------------------------
City | CLINTON
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72031-6657
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-745-3388
-----------------------------------------------------
Fax | 501-745-3006
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | E3154
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------