Provider Demographics
NPI:1740289800
Name:ARNOLD, JEFFREY LYNN (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:LYNN
Last Name:ARNOLD
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:PO BOX 22010
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76702-2010
Mailing Address - Country:US
Mailing Address - Phone:254-761-8811
Mailing Address - Fax:254-761-8815
Practice Address - Street 1:6614 SANGER AVE
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-4253
Practice Address - Country:US
Practice Address - Phone:254-537-6100
Practice Address - Fax:254-537-6101
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1445207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121270605Medicaid
TXOON59XOtherBCBS TEXAS
TX8113B6Medicare PIN
TXG46759Medicare UPIN
00N59XMedicare PIN