Healthcare Provider Details

I. General information

NPI: 1720299647
Provider Name (Legal Business Name): JEREMY SCOTT HARWOOD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 11/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16221 SAINT VINCENT WAY
LITTLE ROCK AR
72223-9072
US

IV. Provider business mailing address

4 CATLETT LN
LITTLE ROCK AR
72211-2194
US

V. Phone/Fax

Practice location:
  • Phone: 501-552-8150
  • Fax: 501-552-8199
Mailing address:
  • Phone: 575-386-9048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberE-7993
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: