Provider Demographics
NPI:1285632463
Name:CHANG, JIMMY C (MD)
Entity Type:Individual
Prefix:
First Name:JIMMY
Middle Name:C
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3343 SPRINGHILL DR
Mailing Address - Street 2:STE 1005
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72117-2930
Mailing Address - Country:US
Mailing Address - Phone:501-758-9251
Mailing Address - Fax:501-758-0308
Practice Address - Street 1:3343 SPRINGHILL DR
Practice Address - Street 2:STE 1005
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-2930
Practice Address - Country:US
Practice Address - Phone:501-758-9251
Practice Address - Fax:501-758-0308
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2010-08-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ARC5948207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
11257000000OtherQUALCHOICE
AR160021272OtherRAILROAD MEDICARE
AR111261001Medicaid
AR242061OtherHEALTHLINK
AR111261001Medicaid
AR242061OtherHEALTHLINK