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General NPI Number Information
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NPI Number | 1629336078
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Entity Type | Individual
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Provider Name | JONATHAN DAVID BRIXEY M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/23/2012
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Last Update Date | 05/23/2016
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Provider Practice Location Address
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Address Line | 101 SKYLINE DR
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City | RUSSELLVILLE
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State | AR
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Zip | 72801-3363
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Country | US
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Telephone | 479-968-2345
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Fax | 479-890-7194
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Provider Business Mailing Address
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Address Line | 101 SKYLINE DR
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City | RUSSELLVILLE
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State | AR
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Zip | 72801-3363
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Country | US
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Telephone | 479-968-2345
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Fax | 479-890-7194
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | E-9597
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License Number State | AR
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | E-9597
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License Number State | AR
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