Provider Demographics
NPI:1609862838
Name:SCOW, ROGER D JR (MD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:D
Last Name:SCOW
Suffix:JR
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 1:712 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:AR
Mailing Address - Zip Code:71753-3412
Mailing Address - Country:US
Mailing Address - Phone:796-524-6304
Mailing Address - Fax:
Practice Address - Street 1:712 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:AR
Practice Address - Zip Code:71753-3412
Practice Address - Country:US
Practice Address - Phone:796-524-6304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE5489207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200125940AMedicaid
TX048061802Medicaid
AR167236001Medicaid
AR167236001Medicaid
AR5H059Medicare PIN