Provider Demographics
NPI:1043386139
Name:JAMES D STUDDARD, MD, P.A.
Entity Type:Organization
Organization Name:JAMES D STUDDARD, MD, P.A.
Other - Org Name:LITTLE ROCK GYNECOLOGY CLINIC, P.A.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:STUDDARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-225-9905
Mailing Address - Street 1:904 AUTUMN RD STE 500
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3738
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:904 AUTUMN RD STE 500
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3738
Practice Address - Country:US
Practice Address - Phone:501-225-9905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC4534207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR11579002Medicaid
AR160005900OtherRR MEDICARE
AR160005900OtherRR MEDICARE
ARD04940Medicare UPIN