Provider Demographics
NPI:1568414704
Name:YOUMANS, ROGER W (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:W
Last Name:YOUMANS
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 1:451 S HOLLY ST
Mailing Address - Street 2:
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-3018
Mailing Address - Country:US
Mailing Address - Phone:479-524-3141
Mailing Address - Fax:479-524-3090
Practice Address - Street 1:451 S HOLLY ST
Practice Address - Street 2:
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761-3018
Practice Address - Country:US
Practice Address - Phone:479-524-3141
Practice Address - Fax:479-524-3090
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE0638207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5J805OtherBCBS AR
OK100108430AMedicaid
AR127823001Medicaid
OK731548933001OtherBCBS OK
OK100108430AMedicaid
AR127823001Medicaid
G10765Medicare UPIN