Provider Demographics
NPI:1265172928
Name:ERWIN, JAKE (MD)
Entity type:Individual
Prefix:DR
First Name:JAKE
Middle Name:
Last Name:ERWIN
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 1:3201 SPRINGHILL DR STE 300
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72117-2909
Mailing Address - Country:US
Mailing Address - Phone:501-753-4132
Mailing Address - Fax:
Practice Address - Street 1:757 E FRONT ST
Practice Address - Street 2:
Practice Address - City:LONOKE
Practice Address - State:AR
Practice Address - Zip Code:72086-3219
Practice Address - Country:US
Practice Address - Phone:501-266-7265
Practice Address - Fax:501-266-7269
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-30
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ARE-17316207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program