Organization
ROGER N. BISE, MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROGER NEAL BISE MD (OWNER)
(479) 478-8555
Entity
Organization
Contact information
Practice address
2713 S 74TH ST, SUITE 302, FORT SMITH, AR 72903-5170
(479) 478-8555
Mailing address
2713 S 74TH ST, SUITE 302, FORT SMITH, AR 72903-5170
(479) 478-8555
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
MC2185
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
148093002
—
AR
01
—
17633000000
QUALCHOICE
AR
01
—
CK2325
RAILROAD MEDICARE
—
Enumeration date
09/27/2006
Last updated
11/05/2009
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