Provider Demographics
NPI:1881285187
Name:JTD MD PLLC
Entity type:Organization
Organization Name:JTD MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMERER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-408-4466
Mailing Address - Street 1:1794 E JOYCE BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-5257
Mailing Address - Country:US
Mailing Address - Phone:479-234-4499
Mailing Address - Fax:479-269-1325
Practice Address - Street 1:1794 E JOYCE BLVD STE 3
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5257
Practice Address - Country:US
Practice Address - Phone:479-234-4499
Practice Address - Fax:479-269-1325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-29
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty