Provider Demographics
NPI:1760557714
Name:PHILLIP R ALSTON MD PA
Entity Type:Organization
Organization Name:PHILLIP R ALSTON MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:ALSTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-752-9251
Mailing Address - Street 1:3343 SPRINGHILL DR
Mailing Address - Street 2:STE 1005
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72117-2930
Mailing Address - Country:US
Mailing Address - Phone:501-758-9251
Mailing Address - Fax:501-758-0308
Practice Address - Street 1:3343 SPRINGHILL DR
Practice Address - Street 2:STE 1005
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-2930
Practice Address - Country:US
Practice Address - Phone:501-758-9251
Practice Address - Fax:501-758-0308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR105215001Medicaid
AR5G595Medicare PIN