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Individual

ASHLEY L BURNHAM

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
3301 W MAIN PL, RUSSELLVILLE, AR 72801-2334
(479) 968-7930
(479) 968-1673
Mailing address
PO BOX 9178, RUSSELLVILLE, AR 72811-9178
(479) 968-7930
(479) 968-4331

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
E1520
AR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
142806001
AR
01
5L804
BCBS PROVIDER NUMBER
AR
Enumeration date
06/13/2006
Last updated
01/11/2019
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