Healthcare Provider Details

I. General information

NPI: 1700976362
Provider Name (Legal Business Name): KENDALL STANFORD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 03/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MARSHALL ST # 653
LITTLE ROCK AR
72202-3510
US

IV. Provider business mailing address

800 MARSHALL ST # 653
LITTLE ROCK AR
72202-3510
US

V. Phone/Fax

Practice location:
  • Phone: 501-364-1050
  • Fax: 501-364-6931
Mailing address:
  • Phone: 501-364-1050
  • Fax: 501-364-6931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberE-2363
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: