Individual
RODGER C DICKINSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1504 SE 28TH ST, BENTONVILLE, AR 72712-3988
(479) 273-1111
(479) 273-1255
Mailing address
1504 SE 28TH ST, BENTONVILLE, AR 72712-3988
(479) 273-1111
(479) 273-1255
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
C4563
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
126591001
—
AR
05
—
207996307
—
MO
Enumeration date
01/31/2006
Last updated
10/08/2009
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