Healthcare Provider Details

I. General information

NPI: 1932242153
Provider Name (Legal Business Name): JARED JUSTIN SEALE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 07/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 FAIR PARK BLVD
LITTLE ROCK AR
72204
US

IV. Provider business mailing address

800 FAIR PARK BLVD
LITTLE ROCK AR
72204-1720
US

V. Phone/Fax

Practice location:
  • Phone: 501-663-3647
  • Fax: 501-978-2630
Mailing address:
  • Phone: 501-663-3647
  • Fax: 501-978-2630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberE-5676
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: