Provider Demographics
NPI:1477949238
Name:TRAPP, JAMIE DERUSSE (MD)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:DERUSSE
Last Name:TRAPP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:DERUSSE
Other - Last Name:TRAPP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 9662
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72033-9662
Mailing Address - Country:US
Mailing Address - Phone:501-852-1363
Mailing Address - Fax:501-852-1364
Practice Address - Street 1:437 DENISON ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-6127
Practice Address - Country:US
Practice Address - Phone:501-327-1325
Practice Address - Fax:501-327-1328
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-08
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-10411207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty