Provider Demographics
NPI:1881690477
Name:STOREYGARD, ALAN ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:ROBERT
Last Name:STOREYGARD
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 1:11001 EXECUTIVE CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4393
Mailing Address - Country:US
Mailing Address - Phone:501-753-4132
Mailing Address - Fax:501-753-4176
Practice Address - Street 1:3201 SPRINGHILL DR STE 300
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-2909
Practice Address - Country:US
Practice Address - Phone:501-753-4132
Practice Address - Fax:501-753-4176
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARN6020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR104978001Medicaid
55134Medicare ID - Type Unspecified
AR104978001Medicaid