Healthcare Provider Details

I. General information

NPI: 1497951842
Provider Name (Legal Business Name): ALICE JIANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 07/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E 6TH ST
TEXARKANA AR
71854-5207
US

IV. Provider business mailing address

300 E 6TH ST
TEXARKANA AR
71854-5207
US

V. Phone/Fax

Practice location:
  • Phone: 870-779-6000
  • Fax: 870-779-6093
Mailing address:
  • Phone: 870-779-6000
  • Fax: 870-779-6093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: