Basic Information
| Provider Information | |||||||||
| NPI: | 1790758985 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THURLBY | ||||||||
| FirstName: | JEFFERSON | ||||||||
| MiddleName: | ROBERT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1867 | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727021867 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8778989892 | ||||||||
| FaxNumber: | 9183922941 | ||||||||
| Practice Location | |||||||||
| Address1: | 3215 N NORTHHILLS BLVD | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727034424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4794631000 | ||||||||
| FaxNumber: | 4794635573 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2006 | ||||||||
| LastUpdateDate: | 04/17/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 21664 | OK | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 0101242416 | VA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | E7407 | AR | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 191009001 | 05 | AR | MEDICAID |