Provider Demographics
NPI:1467436725
Name:LEA, JARRETT BOYD (MD)
Entity Type:Individual
Prefix:DR
First Name:JARRETT
Middle Name:BOYD
Last Name:LEA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11001 EXECUTIVE CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4393
Mailing Address - Country:US
Mailing Address - Phone:501-847-0289
Mailing Address - Fax:501-847-8748
Practice Address - Street 1:4411 HIGHWAY 5 N
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-7005
Practice Address - Country:US
Practice Address - Phone:501-847-0289
Practice Address - Fax:501-847-8748
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE4782207QA0505X
ARE-4782207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR161190001Medicaid
AR5N589Medicare PIN
AR161190-001Medicaid