Provider Demographics
NPI:1669575569
Name:TROXEL, ROGER LEE (MD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:LEE
Last Name:TROXEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 497
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:AR
Mailing Address - Zip Code:72006-0497
Mailing Address - Country:US
Mailing Address - Phone:870-347-2534
Mailing Address - Fax:870-347-2023
Practice Address - Street 1:416 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-3108
Practice Address - Country:US
Practice Address - Phone:870-333-5475
Practice Address - Fax:870-333-5479
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC8313207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR122308001Medicaid
AR122308001Medicaid
AR55985Medicare ID - Type Unspecified