Provider Demographics
NPI:1619955945
Name:ANDERSSON, JEANINE A (MD)
Entity Type:Individual
Prefix:DR
First Name:JEANINE
Middle Name:A
Last Name:ANDERSSON
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 1:800 FAIR PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204
Mailing Address - Country:US
Mailing Address - Phone:501-664-4088
Mailing Address - Fax:501-664-7113
Practice Address - Street 1:800 FAIR PARK BLVD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204
Practice Address - Country:US
Practice Address - Phone:501-664-4088
Practice Address - Fax:501-664-7113
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-3400207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR157561001Medicaid
AR5N258C207OtherMEDICARE
AR5N258Medicare ID - Type Unspecified
ARI35596Medicare UPIN
ARP00232379Medicare PIN