Provider Demographics
NPI:1629561808
Name:CISNEROS, JAMIE C (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:C
Last Name:CISNEROS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 251420
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72225-1420
Mailing Address - Country:US
Mailing Address - Phone:501-686-8000
Mailing Address - Fax:501-526-5148
Practice Address - Street 1:1617 N WASHINGTON
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:AR
Practice Address - Zip Code:71753-2046
Practice Address - Country:US
Practice Address - Phone:870-234-7676
Practice Address - Fax:870-562-2559
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE-14391207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine