Provider Demographics
NPI:1902832660
Name:TITUS, JANET LYNN (MD)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:LYNN
Last Name:TITUS
Suffix:
Gender:F
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 8158
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-0003
Mailing Address - Country:US
Mailing Address - Phone:479-582-3366
Mailing Address - Fax:479-582-5843
Practice Address - Street 1:63 W SUNBRIDGE DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-1825
Practice Address - Country:US
Practice Address - Phone:479-582-3366
Practice Address - Fax:479-582-5843
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR-3125208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR106438001Medicaid
ARP00315086OtherRR MCR
AR55357OtherAR BC/BS
ARP00315086OtherRR MCR
ARD04963Medicare UPIN
AR55357F220Medicare PIN