Healthcare Provider Details

I. General information

NPI: 1548465834
Provider Name (Legal Business Name): JARED R SPENCER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 03/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6823 ISAAC'S ORCHARD RD
SPRINGDALE AR
72762
US

IV. Provider business mailing address

6823 ISAAC'S ORCHARD RD
SPRINGDALE AR
72762
US

V. Phone/Fax

Practice location:
  • Phone: 479-750-2080
  • Fax: 479-750-2082
Mailing address:
  • Phone: 479-750-2080
  • Fax: 479-750-2082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberA95600
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number37260
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberE6045
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: