Provider Demographics
NPI:1942276316
Name:MAROTTE, JEFFREY B (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:B
Last Name:MAROTTE
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 1:495 HOGAN LANE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034
Mailing Address - Country:US
Mailing Address - Phone:501-327-5850
Mailing Address - Fax:501-327-4910
Practice Address - Street 1:495 HOGAN LANE
Practice Address - Street 2:SUITE 2
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034
Practice Address - Country:US
Practice Address - Phone:501-327-5850
Practice Address - Fax:501-327-4910
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-4464208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR159858001Medicaid
AR5N269Medicare ID - Type Unspecified
ARI38375Medicare UPIN
5N269Medicare UPIN