Healthcare Provider Details

I. General information

NPI: 1972281855
Provider Name (Legal Business Name): JARED SPENCER MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2023
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 W VAN ASCHE LOOP
FAYETTEVILLE AR
72703-4974
US

IV. Provider business mailing address

137 W VAN ASCHE LOOP
FAYETTEVILLE AR
72703-4974
US

V. Phone/Fax

Practice location:
  • Phone: 479-751-7000
  • Fax: 479-379-8331
Mailing address:
  • Phone: 479-751-7000
  • Fax: 479-379-8331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: TARA PRATER
Title or Position: OFFICE MANAGER
Credential:
Phone: 501-580-5297