MEDICARE: MR. JEFF J MASHBURN MS, CCC

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	231H00000X	Audiologist	191	OK

General Provider Information

NPI Number	:	1730224569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFF J MASHBURN MS, CCC

Provider Business Mailing Address
First Line	:	230 HIGHWAY 65 N
Second Line	:	SUITE 9
City	:	CLINTON
State	:	AR
Zip	:	72031-6390
Country	:	US
Telephone Number	:	501-745-2280
Fax Number	:	501-745-7530

Provider Business Practice Location Address
First Line	:	230 HIGHWAY 65 N
Second Line	:	SUITE 9
City	:	CLINTON
State	:	AR
Zip	:	72031-6390
Country	:	US
Telephone Number	:	501-745-2280
Fax Number	:	501-745-7530

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

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	09/15/2014

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