Organization
DAVID C JACKS MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JUDY FRIZIELLE LPN (BILLING MANAGER/ NURSE)
(870) 535-4221
Entity
Organization
Contact information
Practice address
4303 S MULBERRY ST, PINE BLUFF, AR 71603-7017
(870) 535-4221
(870) 535-4228
Mailing address
4303 S MULBERRY ST, PINE BLUFF, AR 71603-7017
(870) 535-4221
(870) 535-4228
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
C5066
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104930001
—
AR
Enumeration date
02/18/2008
Last updated
11/15/2013
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