# DR. ROBERT TYRAY JIMMERSON II

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1619046679
- **Gender:** Man
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | E-1845 | AR | Yes |

## Other

- **Enumeration date:** 11/06/2006
- **Last updated:** 06/27/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 080158974 | PALMETTOGBA | AR |
| 05 | — | 135241001 | — | AR |
| 01 | — | 18321000000 | QUAL CHOICE | — |
| 01 | — | 2451550 | AETNA | — |
| 01 | — | 2717169 | CIGNA | — |
| 01 | — | 5K890 | BCBS | AR |