Provider Demographics
NPI:1215314877
Name:BROUGHTON, STEPHEN THOMAS (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:THOMAS
Last Name:BROUGHTON
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 1:5315 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-1858
Mailing Address - Country:US
Mailing Address - Phone:501-664-0941
Mailing Address - Fax:501-666-3956
Practice Address - Street 1:5315 W 12TH ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-1858
Practice Address - Country:US
Practice Address - Phone:501-664-0941
Practice Address - Fax:501-666-3956
Is Sole Proprietor?:No
Enumeration Date:2015-05-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE16510207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology