Individual
DR. ROBERT TYRAY JIMMERSON II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
500 S UNIVERSITY AVE, SUITE 515, LITTLE ROCK, AR 72205-5306
(501) 569-9961
(501) 400-8649
Mailing address
500 S UNIVERSITY AVE, SUITE 515, LITTLE ROCK, AR 72205-5306
(501) 569-9961
(501) 400-8649
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
E-1845
AR
Other
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
Enumeration date
11/06/2006
Last updated
06/27/2014
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