Provider Demographics
NPI:1831178524
Name:HAMBY, JEFFREY D (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:D
Last Name:HAMBY
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 6968
Mailing Address - Street 2:30 NORTHRIDGE DRIVE
Mailing Address - City:VAN BUREN
Mailing Address - State:AR
Mailing Address - Zip Code:72956-0961
Mailing Address - Country:US
Mailing Address - Phone:479-922-9355
Mailing Address - Fax:479-922-2047
Practice Address - Street 1:30 NORTHRIDGE DR
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956-6668
Practice Address - Country:US
Practice Address - Phone:479-922-9355
Practice Address - Fax:479-922-2047
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-0957207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR131118001Medicaid
AR5K256OtherBLUECROSS BLUESHIELD
AR5K256Medicare ID - Type Unspecified
AR5K256OtherBLUECROSS BLUESHIELD