Provider Demographics
NPI:1740356153
Name:LINDSAY, JASON TEAGUE (MD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:TEAGUE
Last Name:LINDSAY
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:15 GREEN VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-8102
Mailing Address - Country:US
Mailing Address - Phone:870-701-0490
Mailing Address - Fax:870-701-0491
Practice Address - Street 1:15 GREEN VALLEY DR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-8102
Practice Address - Country:US
Practice Address - Phone:870-701-0490
Practice Address - Fax:870-701-0491
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2020-06-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ARE4783208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR167290001Medicaid
ARE4783OtherSTATE LICENSE
ARE4783OtherSTATE LICENSE