Provider Demographics
NPI:1740626480
Name:SHAWN CONES MD PLLC PA
Entity type:Organization
Organization Name:SHAWN CONES MD PLLC PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:CONES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-904-3146
Mailing Address - Street 1:1100 N UNIVERSITY AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72207-6351
Mailing Address - Country:US
Mailing Address - Phone:501-904-3146
Mailing Address - Fax:501-904-3149
Practice Address - Street 1:1100 N UNIVERSITY AVE STE 102
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72207-6351
Practice Address - Country:US
Practice Address - Phone:501-904-3146
Practice Address - Fax:501-904-3149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-21
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE5860207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR179101001Medicaid
5G768Medicare PIN