Healthcare Provider Details

I. General information

NPI: 1023004801
Provider Name (Legal Business Name): GARRY JONES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 12/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S UNIVERSITY AVE SUITE 505
LITTLE ROCK AR
72205-5307
US

IV. Provider business mailing address

500 S UNIVERSITY AVE SUITE 505
LITTLE ROCK AR
72205-5307
US

V. Phone/Fax

Practice location:
  • Phone: 501-664-4532
  • Fax: 501-663-4335
Mailing address:
  • Phone: 501-664-4532
  • Fax: 501-663-4335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberC-4547
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberC-4547
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: