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DR. JACKIE R WHITE MD

>> Family Medicine >> Allopathic & Osteopathic Physicians

Registrant NPI Number: 1417964107

Individual Registrant:
DR. JACKIE R WHITE MD
Gender: M
Not Sole Proprietor

Location and contact information for practice:
201 N WALNUT  IMBODEN, AR 72434 US
Tel: 870-869-3101  Fax: 870-869-3014

Contact information for business:
PO BOX 128 201 N WALNUT IMBODEN, AR 72434 US
Tel: 870-869-3101  Fax: 870-869-3014

Registration Information:
NPI: 1417964107
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y207Q00000XAllopathic & Osteopathic Physicians
Family Medicine
ARC5252

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
PRUDENTIAL71083666900201
AETNA718213201




HEALTH CARE JOBS AR - Page 1



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