Dr Jackie R White, MD is a
Family Medicine physician based in Imboden, Arkansas. Dr Jackie R White is licensed to practice in Arkansas (license number C5252) and his current practice location is 201 N Walnut, Imboden, Arkansas. He can be reached at his office (for appointments etc.) via phone at
(870) 869-3101.
NPI number for Dr Jackie R White is 1417964107 and his current mailing address is Po Box 128, 201 N Walnut, Imboden, Arkansas. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1417964107.
Physician's Profile
| Full Name | Dr Jackie R White |
|---|
| Gender | Male |
|---|
| Speciality | Family Medicine |
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| Location | 201 N Walnut, Imboden, Arkansas |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1417964107
- Provider Enumeration Date: 08/02/2006
- Last Update Date: 07/08/2007
Medical Identifiers
Medical identifiers for Dr Jackie R White such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1417964107 | NPI | - | NPPES |
| 710836669002 | Other | | PRUDENTIAL |
| 7182132 | Other | | AETNA |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 207Q00000X | Family Medicine | C5252 (Arkansas) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Jackie R White is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Dr Jackie R White, MD
Po Box 128, 201 N Walnut,
Imboden, AR 72434
Ph: (870) 869-3101 | Dr Jackie R White, MD
201 N Walnut,
Imboden, AR 72434
Ph: (870) 869-3101 |
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