Provider Demographics
NPI:1386605491
Name:DOW, JOHN TIMOTHY (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:TIMOTHY
Last Name:DOW
Suffix:
Gender:M
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 1331
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72403-1331
Mailing Address - Country:US
Mailing Address - Phone:870-972-8181
Mailing Address - Fax:870-974-7001
Practice Address - Street 1:1300 INDUSTRIAL PARK DR
Practice Address - Street 2:
Practice Address - City:TRUMANN
Practice Address - State:AR
Practice Address - Zip Code:72472-9702
Practice Address - Country:US
Practice Address - Phone:870-412-1122
Practice Address - Fax:870-418-1126
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14292207Q00000X
ARN-6770207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR110952001Medicaid
C68175Medicare UPIN
AR110952001Medicaid
AR110952001Medicaid