Healthcare Provider Details

I. General information

NPI: 1750382958
Provider Name (Legal Business Name): JACK ALDRICH CATES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 MALVERN AVE
HOT SPRINGS AR
71901-7132
US

IV. Provider business mailing address

1710 MALVERN AVE
HOT SPRINGS AR
71901-7132
US

V. Phone/Fax

Practice location:
  • Phone: 501-624-3376
  • Fax: 501-624-5609
Mailing address:
  • Phone: 501-624-3376
  • Fax: 501-624-5609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberR-2487
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: