Provider Demographics
NPI:1336145218
Name:STERNBERG, JACK JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:JAY
Last Name:STERNBERG
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 1:1000 N UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72207-6347
Mailing Address - Country:US
Mailing Address - Phone:501-661-0060
Mailing Address - Fax:501-661-1233
Practice Address - Street 1:1000 N UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72207-6347
Practice Address - Country:US
Practice Address - Phone:501-661-0060
Practice Address - Fax:501-661-1233
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC5323173000000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARC5323OtherLICENSE NUMBER
AR104618001Medicaid
ARC5323OtherLICENSE NUMBER
ARD09045Medicare UPIN