Individual
ALLEN CHARLES JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
624 HOSPITAL DR, MOUNTAIN HOME, AR 72653-2955
(870) 365-2076
Mailing address
PO BOX 1449, MOUNTAIN HOME, AR 72654-1449
(870) 424-3181
(870) 424-3089
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
R3563
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
112301001
—
AR
Enumeration date
11/02/2005
Last updated
02/19/2019
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