Healthcare Provider Details

I. General information

NPI: 1891134474
Provider Name (Legal Business Name): JESUS ALBERTO MORENO MUNOZ M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2013
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 S TENNESSEE ST JEFFERSON COMPREHENSIVE CARE SYSTEM
PINE BLUFF AR
71601-5801
US

IV. Provider business mailing address

1101 S TENNESSEE ST JEFFERSON COMPREHENSIVE CARE SYSTEM
PINE BLUFF AR
71601-5801
US

V. Phone/Fax

Practice location:
  • Phone: 870-543-2380
  • Fax:
Mailing address:
  • Phone: 870-543-2380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberE-10074
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: