1164491270 NPI number — DR. JAMES DOUGLAS STUDDARD MD

Table of content: (NPI 1053904706)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164491270 NPI number — DR. JAMES DOUGLAS STUDDARD MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STUDDARD
Provider First Name:
JAMES
Provider Middle Name:
DOUGLAS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164491270
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/15/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1900 MALVERN AVENUE
Provider Second Line Business Mailing Address:
STE 401
Provider Business Mailing Address City Name:
HOT SPRINGS
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
71901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-623-6455
Provider Business Mailing Address Fax Number:
501-623-7257

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9501 BAPTIST HEALTH DR
Provider Second Line Business Practice Location Address:
STE. 800
Provider Business Practice Location Address City Name:
LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72205-6225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-223-2080
Provider Business Practice Location Address Fax Number:
501-223-2088
Provider Enumeration Date:
03/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207VX0000X , with the licence number:  26911 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VX0000X , with the licence number: C-4534 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7420073 . This is a "UNITEDHEALTHCARE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 104711001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4211921 . This is a "AETNA" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 11273000000 . This is a "QUALCHOICE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 55171 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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