Provider Demographics
NPI:1982671897
Name:STOCKDALE, DONOVAN RITCHIE (MD)
Entity Type:Individual
Prefix:
First Name:DONOVAN
Middle Name:RITCHIE
Last Name:STOCKDALE
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 1:1000 EAST MATTHEWS SUITE E
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-4344
Mailing Address - Country:US
Mailing Address - Phone:870-336-0472
Mailing Address - Fax:870-336-5321
Practice Address - Street 1:1000 EAST MATTHEWS SUITE E
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4344
Practice Address - Country:US
Practice Address - Phone:870-336-0472
Practice Address - Fax:870-336-5320
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE2819207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR154531001Medicaid
AR154531001Medicaid
AR5M910Medicare PIN