Provider Demographics
NPI:1346297488
Name:ROUTSONG, RODNEY TERRILL (DO, FACOS)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:TERRILL
Last Name:ROUTSONG
Suffix:
Gender:M
Credentials:DO, FACOS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1758
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72757-1758
Mailing Address - Country:US
Mailing Address - Phone:479-636-9495
Mailing Address - Fax:479-636-9449
Practice Address - Street 1:3301 WEST HUDSON RD.
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756
Practice Address - Country:US
Practice Address - Phone:479-636-9495
Practice Address - Fax:479-636-9449
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE4245208D00000X, 207Q00000X, 208D00000X
OH34007334207T00000X
MOR9145207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR154759003Medicaid
AR154759003Medicaid
5N001Medicare ID - Type Unspecified
AR154759003Medicaid