Havdala, Jack
Havdala, Jack is an individual health care provider with primary practice located at 201 E Oak Ave , Jonesboro AR 72401. He recently has only one registered license in Allopathic & Osteopathic Physicians / Vascular Surgery, which is considered as his primary health care specialty. Havdala, Jack can be contacted via phone (870) 935-6729.Contact Information
Primary practice address
201 E Oak Ave
Jonesboro AR 72401
Phone: (870) 935-6729
Fax: (870) 268-4408
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Vascular Surgery | 2086S0129X | E3961 | Arkansas |
Profile Details
| NPI number | 1477558955 |
|---|---|
| LBN Legal business name | Havdala, Jack |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 20th, 2005 |
| Last updated | Mar 7th, 2023 - about last year |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1477558955 | NPPES |
| Arkansas | Other | E3961 | STATE LICENSE |
| Arkansas | MEDICAID | 32638100 | STATE LICENSE |
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