Healthcare Provider Details

I. General information

NPI: 1124945290
Provider Name (Legal Business Name): DANIEL ALEJANDRO MEDINA NEIRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E WASHINGTON AVE
JONESBORO AR
72401-3111
US

IV. Provider business mailing address

300 CARSON ST
JONESBORO AR
72401-3104
US

V. Phone/Fax

Practice location:
  • Phone: 870-910-7799
  • Fax: 870-336-2999
Mailing address:
  • Phone: 870-910-7799
  • Fax: 870-336-2999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: