DR. JACK HAVDALA (NPI# 1477558955) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1477558955 |
Entity Type | Individual |
Full Name | DR. JACK HAVDALA |
Credential | M.D. |
Practice Address |
201 E Oak Ave Jonesboro AR 72401 |
Practice Telephone | 8709356729 |
Practice Fax Number | 8702684408 |
Mailing Telephone | 8709356729 |
Mailing Fax Number | 8702684408 |
Enumeration Date | 2005-06-20 |
Last Update Date | 2011-03-29 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 2086S0129X |
Surgery Specialization: Vascular Surgery |
E3961 | AR | Allopathic & Osteopathic Physicians |
State | Issuer | Identifier | Type Code |
---|---|---|---|
AR | DEA NUMBER | BH3597828 | 01 |
AR | 32638100 | 05 | |
AR | STATE LICENSE | E3961 | 01 |
Street Address |
201 E OAK AVE |
City | JONESBORO |
State | AR |
Zip Code | 72401 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1962407940 | Ammar Al-hallak | Internal Medicine | 201 E Oak Ave, Jonesboro, AR 72401 | 2005-06-16 |
1326655416 | Taylor S Long | Nurse Practitioner | 201 E Oak Ave, Jonesboro, AR 72401-4163 | 2020-09-23 |
1487269726 | Rachael Richardson | Nurse Practitioner | 201 E Oak Ave, Jonesboro, AR 72401-4163 | 2020-09-14 |
1568070761 | Brittany Spence | Nurse Practitioner | 201 E Oak Ave, Jonesboro, AR 72401-4163 | 2020-07-14 |
1619445632 | Georgia L. Wooten | Nurse Practitioner | 201 E Oak Ave, Jonesboro, AR 72401-4163 | 2018-11-07 |
1063987667 | Amanda Michelle Anderson | Nurse Practitioner | 201 E Oak Ave, Jonesboro, AR 72401-4163 | 2018-10-10 |
1053819417 | Kristen Paige Neldon | Nurse Practitioner | 201 E Oak Ave, Jonesboro, AR 72401-4163 | 2018-01-31 |
1750899266 | Kelly Michele Mccain | Nurse Practitioner | 201 E Oak Ave, Jonesboro, AR 72401-4163 | 2018-01-18 |
1316466154 | Rachel Cohen | Clinical Nurse Specialist | 201 E Oak Ave, Jonesboro, AR 72401-4163 | 2017-09-13 |
1174048201 | Shayna Nunn | Nurse Practitioner | 201 E Oak Ave, Jonesboro, AR 72401-4163 | 2017-08-09 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1407453368 | Mariah Kay Jackson | Physical Therapy Assistant | Creative Kids Therapy, Jonesboro, AR 72401 | 2020-10-05 |
1821606005 | Kafayat Folake Iyanda | Specialist/Technologist | 2105 East Aggie Rd, Jonesboro, AR 72401 | 2020-07-14 |
1053936310 | Josh Roberts | Physical Therapist | 1010 South Main St, Jonesboro, AR 72401 | 2020-06-12 |
1003449687 | Amy Mary Elizabeth Daughhetee | Nurse Practitioner | 225 East Washington Ave, Jonesboro, AR 72401 | 2020-02-21 |
1871126698 | Sarah Lowtharp | Clinical Nurse Specialist | 225 East Washington Ave., Jonesboro, AR 72401 | 2020-02-20 |
1891335519 | Mallori Miller | Case Manager/Care Coordinator | 837 Willett Rd, Jonesboro, AR 72401 | 2020-01-10 |
1265073704 | Michael Bruce Collie | Registered Nurse | 837 Williett Road, Jonesboro, AR 72401 | 2019-10-07 |
1285283432 | Jonesboro Ambulatory Surgery Center, LLC | Clinic/Center | 1710 Mayfield Dr, Jonesboro, AR 72401 | 2019-09-10 |
1841843943 | Destinee Katrina Cole | Specialist/Technologist | 2015 Aggie Rd, Jonesboro, AR 72401 | 2019-07-18 |
1699250472 | Jessica Marie Mcnatt | Occupational Therapist | 907 County Road 753, Jonesboro, AR 72401 | 2018-09-27 |
Find all providers in zip 72401 |
Taxonomy Code | 2086S0129X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Surgery |
Specialization | Vascular Surgery |
A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1528220639 | Matthew Brewster Hendrich | Surgery | 201 E Oak Ave, Jonesboro, AR 72401-4163 | 2008-06-30 |
1558366443 | Daniel Richard Stevenson | Surgery | 201 E Oak Ave., Jonesboro, AR 72401 | 2005-06-16 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1235778515 | Arkansas Vascular Surgery, Pllc | Surgery | 11300 N Rodney Parham Rd Ste 210, Little Rock, AR 72212-4149 | 2020-01-03 |
1063741924 | Lon G. Bitzer, M.d., P.a. | Surgery | 1801 W 40th Ave Ste 4c, Pine Bluff, AR 71603-6961 | 2009-12-23 |
1346317476 | Arkansas Health Group | Surgery | 9601 Lile Dr Ste 250, Medical Towers 1, Little Rock, AR 72205-6355 | 2006-11-30 |
1760498554 | Edward C. Loebl | Surgery | 9601 Lile Drive, Suite 250, Little Rock, AR 72205-6321 | 2006-07-31 |
1962466748 | Donald L Patrick | Surgery | 305 Rodgers Dr, Searcy, AR 72143-7432 | 2006-04-17 |
1225416928 | Usa Vein Clinics of Little Rock, Pllc | Surgery | 609 Sw 8th St, Suite 600, Bentonville, AR 72712-7886 | 2015-05-13 |
1619234366 | Christian Dupre Simmons | Surgery | 4301 W Markham St # 520, Little Rock, AR 72205 | 2012-04-19 |
1386872695 | Jason Leonard Muesse | Surgery | 4301 W Markham St, Little Rock, AR 72205-7101 | 2009-06-24 |
1437260577 | Cardiac and Vascular Surgeons Pa | Surgery | 9601 Lile Dr, Suite 650, Little Rock, AR 72205-6321 | 2006-08-31 |
1871504126 | Mohammed Mahmoud Moursi | Surgery | 4300 W 7th St, 112pv/lr, Little Rock, AR 72205-5446 | 2006-08-11 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.