Provider Demographics
NPI:1275629024
Name:ARCHER, CYNTHIA L (MD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:L
Last Name:ARCHER
Suffix:
Gender:F
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:PO BOX 7422
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83002-7422
Mailing Address - Country:US
Mailing Address - Phone:602-697-7790
Mailing Address - Fax:
Practice Address - Street 1:1335 ARENA RD UNIT 1
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001-8919
Practice Address - Country:US
Practice Address - Phone:602-697-7790
Practice Address - Fax:602-697-7790
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8583747-1205207R00000X
CODR.0055895207R00000X
NV14098207R00000X
AZ31998207R00000X
WY9430A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0784730OtherBCBS
AZ948680Medicaid
AZI35146Medicare UPIN
AZAZ0784730OtherBCBS
AZ030078Medicare Oscar/Certification