Provider Demographics
NPI:1407840101
Name:GEOGHAGAN, JAY DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:DANIEL
Last Name:GEOGHAGAN
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 1:3343 SPRINGHILL DR
Mailing Address - Street 2:STE 1035
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72117-2929
Mailing Address - Country:US
Mailing Address - Phone:501-975-7676
Mailing Address - Fax:501-537-0206
Practice Address - Street 1:3343 SPRINGHILL DR
Practice Address - Street 2:SUITE 1035
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-2929
Practice Address - Country:US
Practice Address - Phone:501-975-7676
Practice Address - Fax:501-537-0206
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88853207RC0000X
ARE-2040207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5N795OtherBLUE CROSS BLUE SHIELD
ARCC6745OtherRAILROAD MEDICARE
ARCN1884OtherRAILROAD MEDICARE
ARL71382Medicare UPIN
AR5N795Medicare PIN