MEDICARE: DR. ETHAN J SCHOCK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	E-2961	AR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	5L876C207	OTHER	AR	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033197215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ETHAN J SCHOCK M.D.

Provider Business Mailing Address
First Line	:	800 FAIR PARK BLVD
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72204-1720
Country	:	US
Telephone Number	:	501-404-8007
Fax Number	:	501-904-3620

Provider Business Practice Location Address
First Line	:	800 FAIR PARK BLVD
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72204
Country	:	US
Telephone Number	:	501-663-3647
Fax Number	:	501-666-9653

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2006
Last Update Date	:	06/01/2026

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