Provider Demographics
NPI:1003843582
Name:JASKEY, DAVID G (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:G
Last Name:JASKEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11001 EXECUTIVE CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4393
Mailing Address - Country:US
Mailing Address - Phone:501-812-7215
Mailing Address - Fax:501-812-7207
Practice Address - Street 1:2915 CYPRESS RD STE D
Practice Address - Street 2:
Practice Address - City:ARKADELPHIA
Practice Address - State:AR
Practice Address - Zip Code:71923-4243
Practice Address - Country:US
Practice Address - Phone:870-246-3055
Practice Address - Fax:870-246-5366
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA39144207V00000X
TXG8876207V00000X
ARE-10481207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3479073-02Medicaid
IA1003843582Medicaid
IAIB1477004Medicare PIN
IA1003843582Medicaid