Provider Demographics
NPI:1316949811
Name:ASHODIAN, STEPHEN PAUL (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:PAUL
Last Name:ASHODIAN
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 1:800 S CHURCH ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-4176
Mailing Address - Country:US
Mailing Address - Phone:870-935-6012
Mailing Address - Fax:870-934-3156
Practice Address - Street 1:800 S CHURCH ST
Practice Address - Street 2:SUITE 400
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4176
Practice Address - Country:US
Practice Address - Phone:870-935-6012
Practice Address - Fax:870-934-3156
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-4059208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR154270001Medicaid
AR5X913OtherBLUE CROSS NUMBER
AR5X913OtherBLUE CROSS NUMBER