Individual
JARED ENNIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4019 N REMINGTON DR, FAYETTEVILLE, AR 72703-6344
(479) 595-8192
(479) 442-1748
Mailing address
4019 N REMINGTON DR, FAYETTEVILLE, AR 72703-6344
(479) 595-8192
(479) 442-1748
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
E-4271
AR
208VP0014X
Interventional Pain Medicine Physician
Primary
E-4271
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
157891001
—
AR
Enumeration date
11/01/2006
Last updated
03/29/2023
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