Healthcare Provider Details

I. General information

NPI: 1336145218
Provider Name (Legal Business Name): JACK JAY STERNBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 06/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N UNIVERSITY AVE
LITTLE ROCK AR
72207-6347
US

IV. Provider business mailing address

1000 N UNIVERSITY AVE
LITTLE ROCK AR
72207-6347
US

V. Phone/Fax

Practice location:
  • Phone: 501-661-0060
  • Fax: 501-661-1233
Mailing address:
  • Phone: 501-661-0060
  • Fax: 501-661-1233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberC5323
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberC5323
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: