Healthcare Provider Details

I. General information

NPI: 1518907807
Provider Name (Legal Business Name): MARVIN WINSTON ASHFORD JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 01/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 RICHARDS ROAD SUITE A
NORTH LITTLE ROCK AR
72117
US

IV. Provider business mailing address

4000 RICHARDS ROAD SUITE A
NORTH LITTLE ROCK AR
72117
US

V. Phone/Fax

Practice location:
  • Phone: 501-758-3999
  • Fax: 501-758-8653
Mailing address:
  • Phone: 501-758-5133
  • Fax: 501-758-5173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberE3997
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: