DR. JACK HAVDALA


Address: 201 E Oak Ave, Jonesboro, AR 72401
Phone: 8709356729

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).

Provider Overview

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

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 2086S0129X Surgery
Specialization: Vascular Surgery
E3961 AR Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
AR DEA NUMBER BH3597828 01
AR 32638100 05
AR STATE LICENSE E3961 01

Office Location

Street Address 201 E OAK AVE
City JONESBORO
State AR
Zip Code 72401

Providers in the same location

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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Providers in the same zip code

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
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Taxonomy Information

Taxonomy Code 2086S0129X
Grouping Allopathic & Osteopathic Physicians
Classification Surgery
Specialization Vascular Surgery

Taxonomy Definition

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.

Providers in the same taxonomy and city

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

Providers in the same taxonomy and state

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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Competitor

Search similar providers

City JONESBORO
Zip Code 72401

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Dataset Information

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.

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