Provider Demographics
NPI:1780765180
Name:JEFF J. CARFAGNO, M.D., P.A.
Entity type:Organization
Organization Name:JEFF J. CARFAGNO, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY PRACTICE PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:J
Authorized Official - Last Name:CARFAGNO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-851-8100
Mailing Address - Street 1:1900 CLUB MANOR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MAUMELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72113
Mailing Address - Country:US
Mailing Address - Phone:501-851-8100
Mailing Address - Fax:
Practice Address - Street 1:1900 CLUB MANOR
Practice Address - Street 2:SUITE 105
Practice Address - City:MAUMELLE
Practice Address - State:AR
Practice Address - Zip Code:72113
Practice Address - Country:US
Practice Address - Phone:501-851-8100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-6805261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR21945Medicare ID - Type Unspecified