Healthcare Provider Details

I. General information

NPI: 1467457358
Provider Name (Legal Business Name): BARRY TEDDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CARSON ST
JONESBORO AR
72401-3104
US

IV. Provider business mailing address

300 CARSON ST
JONESBORO AR
72401-3104
US

V. Phone/Fax

Practice location:
  • Phone: 870-932-1198
  • Fax: 870-910-7700
Mailing address:
  • Phone: 870-932-1198
  • Fax: 870-910-7700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberR3800
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberR3800
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: