Provider Demographics
NPI:1609819077
Name:BINGHAM, JENNIFER (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BINGHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 SHIPLEY ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-6348
Mailing Address - Country:US
Mailing Address - Phone:479-351-9534
Mailing Address - Fax:479-287-4586
Practice Address - Street 1:1200 SHIPLEY ST
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-6348
Practice Address - Country:US
Practice Address - Phone:479-351-9534
Practice Address - Fax:479-287-4586
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE1940207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR135065001Medicaid
ARF80368Medicare UPIN
AR5K945Medicare PIN
AR135065001Medicaid