Provider Demographics
NPI:1780685123
Name:JEFFERS PERRY, ROBIN (MD)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:JEFFERS PERRY
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 1:4202 S UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-7841
Mailing Address - Country:US
Mailing Address - Phone:501-562-4838
Mailing Address - Fax:501-562-1958
Practice Address - Street 1:4202 S UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-7841
Practice Address - Country:US
Practice Address - Phone:501-562-4838
Practice Address - Fax:501-562-1958
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC6652207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR51513OtherBLUE CROSS BLUE SHIELD
AR11167000000OtherQUALCHOICE
AR120166OtherUNITED HEALTHCARE
AR113533001Medicaid
AR51513Medicare ID - Type Unspecified
AR113533001Medicaid