Provider Demographics
NPI:1710982871
Name:COWARD, KEITH A (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:A
Last Name:COWARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2526 HIGHWAY 65 S
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CLINTON
Mailing Address - State:AR
Mailing Address - Zip Code:72031-6657
Mailing Address - Country:US
Mailing Address - Phone:501-745-3388
Mailing Address - Fax:501-745-3006
Practice Address - Street 1:2526 HIGHWAY 65 S
Practice Address - Street 2:SUITE 201
Practice Address - City:CLINTON
Practice Address - State:AR
Practice Address - Zip Code:72031-6657
Practice Address - Country:US
Practice Address - Phone:501-745-3388
Practice Address - Fax:501-745-3006
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE3154207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR149637001Medicaid
AR03090020300OtherQUALCHOICE
AR03090020300OtherQUALCHOICE
ARP00003120Medicare PIN
AR149637001Medicaid