Provider Demographics
NPI:1780833707
Name:DIXON, JARED A (MD)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:A
Last Name:DIXON
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 1:1304 MILITARY RD
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015-2911
Mailing Address - Country:US
Mailing Address - Phone:501-778-0934
Mailing Address - Fax:501-778-1013
Practice Address - Street 1:1304 MILITARY RD
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-2911
Practice Address - Country:US
Practice Address - Phone:501-778-0934
Practice Address - Fax:501-778-1013
Is Sole Proprietor?:No
Enumeration Date:2008-09-15
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE7567207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR194201001Medicaid
AR194201001Medicaid