Healthcare Provider Details

I. General information

NPI: 1700914694
Provider Name (Legal Business Name): JEFFREY W. HERROLD, M. D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 01/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 MEDICAL PARK PL
HOT SPRINGS AR
71901-8099
US

IV. Provider business mailing address

135 MEDICAL PARK PL
HOT SPRINGS AR
71901-8099
US

V. Phone/Fax

Practice location:
  • Phone: 501-623-2500
  • Fax: 501-623-5155
Mailing address:
  • Phone: 501-623-2500
  • Fax: 501-623-5155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberC6620
License Number StateAR

VIII. Authorized Official

Name: DR. JEFFREY W. HERROLD
Title or Position: OWNER
Credential: M. D.
Phone: 501-623-2500