Provider Demographics
NPI:1073616934
Name:CARFAGNO, JEFFREY JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:JOHN
Last Name:CARFAGNO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 CLUB MANOR DR STE 105
Mailing Address - Street 2:
Mailing Address - City:MAUMELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72113-7443
Mailing Address - Country:US
Mailing Address - Phone:501-851-8100
Mailing Address - Fax:501-851-4712
Practice Address - Street 1:1900 CLUB MANOR DR STE 105
Practice Address - Street 2:
Practice Address - City:MAUMELLE
Practice Address - State:AR
Practice Address - Zip Code:72113-7443
Practice Address - Country:US
Practice Address - Phone:501-851-8100
Practice Address - Fax:501-851-4712
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC6805207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR116678001Medicaid
AR1670460OtherUNITED HEALTHCARE
AR51945OtherBLUE CROSS BLUE SHIELD
11200000040OtherQUALCHOICE
080037331OtherRR MEDICARE
AR51945OtherBLUE CROSS BLUE SHIELD
51945Medicare ID - Type Unspecified