MEDICARE: DR. JASON B HOLDER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	E6594	AR
2	390200000X	Student in an Organized Health Care Education/Training Program		AR
3	207RP1001X	Pulmonary Disease Physician	E6594	AR

General Provider Information

NPI Number	:	1790909950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON B HOLDER MD

Provider Business Mailing Address
First Line	:	5800 W 10TH ST STE 610
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72204-1761
Country	:	US
Telephone Number	:	501-661-9393
Fax Number	:	501-663-4795

Provider Business Practice Location Address
First Line	:	5800 WEST 10TH STREET
Second Line	:	SUITE 610
City	:	LITTLE ROCK
State	:	AR
Zip	:	72204-1761
Country	:	US
Telephone Number	:	150-166-9393
Fax Number	:	501-663-4795

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	03/02/2021

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