Provider Demographics
NPI:1093778136
Name:KOSINSKI, TERRY J (MD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:J
Last Name:KOSINSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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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:870-932-3339
Mailing Address - Fax:870-933-1824
Practice Address - Street 1:333 STADIUM BLVD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401
Practice Address - Country:US
Practice Address - Phone:870-932-3339
Practice Address - Fax:870-933-1824
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE3705207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR03090023800OtherQUALCHOICE
ARP00042712OtherRAILROAD MEDICARE
ARB29080Medicare UPIN
AR03090023800OtherQUALCHOICE