Provider Demographics
NPI:1205943289
Name:ROUSE, JOE P (MD)
Entity type:Individual
Prefix:
First Name:JOE
Middle Name:P
Last Name:ROUSE
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:PO BOX 6063
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72766-6063
Mailing Address - Country:US
Mailing Address - Phone:479-443-0500
Mailing Address - Fax:479-521-3832
Practice Address - Street 1:1306 S PLEASANT ST
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-6223
Practice Address - Country:US
Practice Address - Phone:479-443-0500
Practice Address - Fax:479-521-3832
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC4405207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
012083557OtherUCH
AR106345001Medicaid
122530000OtherDC
122530000OtherDC
AR106345001Medicaid