Provider Demographics
NPI:1811382906
Name:ALLISTON, JEFFREY (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:ALLISTON
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 1:3333 S PINNACLE HILLS PKWY STE 300A
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-9000
Mailing Address - Country:US
Mailing Address - Phone:479-271-7077
Mailing Address - Fax:479-271-7035
Practice Address - Street 1:3333 S PINNACLE HILLS PKWY STE 300A
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-9000
Practice Address - Country:US
Practice Address - Phone:479-271-7077
Practice Address - Fax:479-271-7035
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-06
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE13104208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology