Provider Demographics
NPI:1992716948
Name:WHALEY, STEPHEN ALLEN (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ALLEN
Last Name:WHALEY
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 1:701 S PULASKI ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72201-3926
Mailing Address - Country:US
Mailing Address - Phone:501-682-6223
Mailing Address - Fax:
Practice Address - Street 1:701 S PULASKI ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72201-3926
Practice Address - Country:US
Practice Address - Phone:501-682-6223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-5107208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR105168001Medicaid
AR55609OtherBCBS
AR105168001Medicaid