Healthcare Provider Details

I. General information

NPI: 1790909950
Provider Name (Legal Business Name): JASON B HOLDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 03/02/2021
Certification Date: 03/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 WEST 10TH STREET SUITE 610
LITTLE ROCK AR
72204-1761
US

IV. Provider business mailing address

5800 W 10TH ST STE 610
LITTLE ROCK AR
72204-1761
US

V. Phone/Fax

Practice location:
  • Phone: 150-166-9393
  • Fax: 501-663-4795
Mailing address:
  • Phone: 501-661-9393
  • Fax: 501-663-4795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberE6594
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberE6594
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: