Provider Demographics
NPI:1477639649
Name:ARNOLD, JEFFREY B (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:B
Last Name:ARNOLD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4485 E MOUNT MORRIS RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT MORRIS
Mailing Address - State:MI
Mailing Address - Zip Code:48458-8963
Mailing Address - Country:US
Mailing Address - Phone:810-640-2200
Mailing Address - Fax:810-640-3113
Practice Address - Street 1:4485 E MOUNT MORRIS RD
Practice Address - Street 2:
Practice Address - City:MOUNT MORRIS
Practice Address - State:MI
Practice Address - Zip Code:48458-8963
Practice Address - Country:US
Practice Address - Phone:810-640-2200
Practice Address - Fax:810-640-3113
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101008495207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4282121Medicaid
MIM23560005Medicare PIN
MI4282121Medicaid