Jacks, David
Jacks, David is an sole proprietor health care provider with primary practice located at 4303 S Mulberry St , Pine Bluff AR 71603-7017. He recently has only one registered license in Allopathic & Osteopathic Physicians / Urology, which is considered as his primary health care specialty. Jacks, David can be contacted via phone (870) 535-4221.Contact Information
Primary practice address
4303 S Mulberry St
Pine Bluff AR 71603-7017
Phone: (870) 535-4221
Fax: (870) 535-4228
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Urology | 208800000X | C5066 | Arkansas |
Profile Details
| NPI number | 1093735110 |
|---|---|
| LBN Legal business name | Jacks, David |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jul 20th, 2006 |
| Last updated | Apr 5th, 2022 - about 2 years ago |
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 | 1093735110 | NPPES |
| Arkansas | MEDICAID | 10493001 |
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