Healthcare Provider Details

I. General information

NPI: 1780667618
Provider Name (Legal Business Name): DR HAYES YOUNG & JACOBS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 08/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 FALLS BLVD S
WYNNE AR
72396-3501
US

IV. Provider business mailing address

411 FALLS BLVD S
WYNNE AR
72396-3501
US

V. Phone/Fax

Practice location:
  • Phone: 870-238-3261
  • Fax: 870-238-3115
Mailing address:
  • Phone: 870-238-3261
  • Fax: 870-238-3115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC4111
License Number StateAR

VIII. Authorized Official

Name: DR. JAMES ROBINSON JACOBS
Title or Position: MD
Credential: MD
Phone: 870-238-3261