Provider Demographics
NPI:1801884622
Name:KIRSCH, JEFFREY P (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:P
Last Name:KIRSCH
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 1:2425 DAVE WARD DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-8679
Mailing Address - Country:US
Mailing Address - Phone:501-932-7600
Mailing Address - Fax:501-932-7603
Practice Address - Street 1:2425 DAVE WARD DR
Practice Address - Street 2:STE 101
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-8686
Practice Address - Country:US
Practice Address - Phone:501-932-7600
Practice Address - Fax:501-932-7603
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE2703174400000X
ARE-2703207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR142402001Medicaid
AR142402001Medicaid
ARC17927Medicare UPIN