Provider Demographics
NPI:1225135148
Name:MEHTA, JAWAHAR L (MD)
Entity Type:Individual
Prefix:DR
First Name:JAWAHAR
Middle Name:L
Last Name:MEHTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:79 PEBBLE BEACH DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212-2825
Mailing Address - Country:US
Mailing Address - Phone:501-296-1426
Mailing Address - Fax:501-526-6562
Practice Address - Street 1:4300 W MARKHAM ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-4024
Practice Address - Country:US
Practice Address - Phone:501-296-1426
Practice Address - Fax:501-526-6562
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE2864207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5L793Medicare PIN
ARD57778Medicare UPIN