Healthcare Provider Details

I. General information

NPI: 1285678300
Provider Name (Legal Business Name): JEFFERSON CARTWRIGHT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 01/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 SKYLINE DR
RUSSELLVILLE AR
72801-3395
US

IV. Provider business mailing address

101 SKYLINE DR
RUSSELLVILLE AR
72801-3395
US

V. Phone/Fax

Practice location:
  • Phone: 479-968-2345
  • Fax: 479-890-2497
Mailing address:
  • Phone: 479-968-2345
  • Fax: 479-890-2497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD00042957
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberE-11525
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: