Provider Demographics
NPI:1487664892
Name:ALSTON, JOHN DAVID (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DAVID
Last Name:ALSTON
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 1:3000 MEDICAL CENTER PKWY
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-3217
Mailing Address - Country:US
Mailing Address - Phone:479-751-3202
Mailing Address - Fax:479-756-2721
Practice Address - Street 1:724 DEAVER ST
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-5356
Practice Address - Country:US
Practice Address - Phone:479-751-3202
Practice Address - Fax:479-756-2721
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARC5752208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR105091001Medicaid
OK100067000AMedicaid
OK100067000AMedicaid
AR105091001Medicaid