Provider Demographics
NPI:1457314577
Name:SOUTH, RONALD E (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:E
Last Name:SOUTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 E MATTHEWS AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-4315
Mailing Address - Country:US
Mailing Address - Phone:870-931-4442
Mailing Address - Fax:870-931-4707
Practice Address - Street 1:1107 E MATTHEWS AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4315
Practice Address - Country:US
Practice Address - Phone:870-931-4442
Practice Address - Fax:870-931-4707
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE07062084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR143512002Medicaid
AR134615001Medicaid
ARG69143Medicare UPIN
AR5K778Medicare ID - Type UnspecifiedINDIVIDUAL
AR143512002Medicaid