Provider Demographics
NPI:1154358976
Name:RONALD SCOTT EXUM MD, PA
Entity type:Organization
Organization Name:RONALD SCOTT EXUM MD, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:EXUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-202-4246
Mailing Address - Street 1:904 AUTUMN RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3737
Mailing Address - Country:US
Mailing Address - Phone:501-202-4246
Mailing Address - Fax:501-202-4299
Practice Address - Street 1:3050 TWIN RIVERS DR
Practice Address - Street 2:
Practice Address - City:ARKADELPHIA
Practice Address - State:AR
Practice Address - Zip Code:71923-4218
Practice Address - Country:US
Practice Address - Phone:870-245-2622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC7916282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARF34928Medicare UPIN