Healthcare Provider Details

I. General information

NPI: 1265172928
Provider Name (Legal Business Name): JAKE ERWIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

757 E FRONT ST
LONOKE AR
72086-3219
US

IV. Provider business mailing address

3201 SPRINGHILL DR STE 300
NORTH LITTLE ROCK AR
72117-2909
US

V. Phone/Fax

Practice location:
  • Phone: 501-266-7265
  • Fax: 501-266-7269
Mailing address:
  • Phone: 501-753-4132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE-17316
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: