Provider Demographics
NPI:1275763732
Name:ROGER ALDERSON, MD,PA
Entity Type:Organization
Organization Name:ROGER ALDERSON, MD,PA
Other - Org Name:PLASTIC SURGERY CLINIC OF NORTHWEST ARKANSAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OF ROGER ALDERSON MD,PA
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:WILLIS
Authorized Official - Last Name:ALDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-636-4325
Mailing Address - Street 1:2 HALSTED CIR
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-3184
Mailing Address - Country:US
Mailing Address - Phone:479-636-4325
Mailing Address - Fax:479-636-4329
Practice Address - Street 1:2 HALSTED CIR
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-3184
Practice Address - Country:US
Practice Address - Phone:479-636-4325
Practice Address - Fax:479-636-4329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-19
Last Update Date:2009-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC7239208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR142651002Medicaid
5J351Medicare UPIN