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General NPI Number Information
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NPI Number | 1801869151
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Entity Type | Organization
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Legal Business Name | ROGERS FAMILY AND OCCUPATIONAL MEDICINE CLINIC
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Dates
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Enumeration Date | 02/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1615B WEST PERSIMMON
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City | ROGERS
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State | AR
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Zip | 72756
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Country | US
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Telephone | 479-636-7192
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Fax | 479-621-9749
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Provider Business Mailing Address
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Address Line | 1615B WEST PERSIMMON
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City | ROGERS
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State | AR
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Zip | 72756
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Country | US
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Telephone | 479-636-7192
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Fax | 479-621-9749
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Authorized Official
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Title or Position | PRESIDENT
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Name | TIMOTHY WAYNE YAWN
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Credential | MD
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Telephone | 479-621-9749
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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