Provider Demographics
NPI:1528021649
Name:WARFORD, JEREMY ALAN (MD)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:ALAN
Last Name:WARFORD
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 1:10700 N RODNEY PARHAM RD STE C10
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212-4110
Mailing Address - Country:US
Mailing Address - Phone:501-246-7274
Mailing Address - Fax:
Practice Address - Street 1:10700 N RODNEY PARHAM RD STE C10
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212-4110
Practice Address - Country:US
Practice Address - Phone:501-246-7274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE4220207P00000X
ARE-4220207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR155787001Medicaid
I15746Medicare UPIN
AR5N011Medicare ID - Type Unspecified