Provider Demographics
NPI:1437579455
Name:MCFARLIN, JARED
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:MCFARLIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2551 GREENWOOD RD STE 410
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-3989
Mailing Address - Country:US
Mailing Address - Phone:318-621-2929
Mailing Address - Fax:318-621-2930
Practice Address - Street 1:2551 GREENWOOD RD STE 410
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-3989
Practice Address - Country:US
Practice Address - Phone:318-621-2929
Practice Address - Fax:318-621-2930
Is Sole Proprietor?:No
Enumeration Date:2014-04-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA305060207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2358588Medicaid