Healthcare Provider Details

I. General information

NPI: 1841276003
Provider Name (Legal Business Name): JIMMY L BARROW D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 08/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

534 LUZERNE ST
MOUNT IDA AR
71957
US

IV. Provider business mailing address

PO BOX 1848
MENA AR
71953-1841
US

V. Phone/Fax

Practice location:
  • Phone: 870-867-4244
  • Fax: 870-867-4254
Mailing address:
  • Phone: 479-437-3449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR4457
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: