Provider Demographics
NPI:1508994393
Name:ANDERSON, ROGER WILBERT (MD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:WILBERT
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 N RODNEY PARHAM RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212-4140
Mailing Address - Country:US
Mailing Address - Phone:501-219-8000
Mailing Address - Fax:
Practice Address - Street 1:2200 N RODNEY PARHAM RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212-4140
Practice Address - Country:US
Practice Address - Phone:501-219-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-8360208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery