Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | E3692 | AR |
N | 111NI0900X | Internist | E3692 | AR |
N | 207RR0500X | Rheumatology | E3692 | AR |
N | 208000000X | Pediatrician | E3692 | AR |
Y | 2080P0216X | Pediatric Rheumatologist | E3692 | AR |
NPI | 1962433615 |
---|---|
Provider Name | Jason A. Dare |
First Address | Little Rock, AR 72202-3500 |
Second Address | Little Rock, AR 72202-3500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 07/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03679274 | (05) | MS |
158157001 | (05) | AR |
200075330A | (05) | OK |
I39407 | (02) | AR |