Healthcare Provider Details

I. General information

NPI: 1184697203
Provider Name (Legal Business Name): JEFFREY S MAYFIELD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 06/20/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 WEST CARPENTER STREET
BENTON AR
72015-3349
US

IV. Provider business mailing address

819 WEST CARPENTER STREET
BENTON AR
72015-3349
US

V. Phone/Fax

Practice location:
  • Phone: 501-778-8264
  • Fax: 501-778-7360
Mailing address:
  • Phone: 501-778-8264
  • Fax: 501-778-7360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC8451
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC-8451
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: