Provider Demographics
NPI:1336338797
Name:HOWARD, JERAL DEAN
Entity Type:Individual
Prefix:MR
First Name:JERAL
Middle Name:DEAN
Last Name:HOWARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5309 MCCLANAHAN DR STE F4
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-7075
Mailing Address - Country:US
Mailing Address - Phone:800-280-2050
Mailing Address - Fax:
Practice Address - Street 1:5309 MCCLANAHAN DR STE F4
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-7075
Practice Address - Country:US
Practice Address - Phone:800-280-2050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR0000001546332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR3894640001Medicare NSC