Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | E-4845 | AR |
Y | 2080P0204X | Pediatric Emergency Doctor | E-4845 | AR |
NPI | 1124126081 |
---|---|
Provider Name | Dr. Matthew W. Jaeger |
First Address | Little Rock, AR 72202-3510 |
Second Address | Little Rock, AR 72202-3510 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2006 |
Last Update Date | 25/02/2011 |