MEDICARE: JI MA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	E5328	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497953020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JI MA MD

Provider Business Mailing Address
First Line	:	PO BOX 2420
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72902-2420
Country	:	US
Telephone Number	:	479-709-7399
Fax Number	:	479-709-7053

Provider Business Practice Location Address
First Line	:	1001 TOWSON AVE
Second Line	:
City	:	FT. SMITH
State	:	AR
Zip	:	72901
Country	:	US
Telephone Number	:	479-441-4000
Fax Number	:	479-709-7053

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2007
Last Update Date	:	05/21/2021

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Directions to “ JI MA MD” Practice Location

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