Individual
DR. RANDALL DEAN STALEY JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4700 S THOMPSON ST STE C103, SPRINGDALE, AR 72764
(479) 571-6363
(479) 684-3941
Mailing address
PO BOX 1523, FAYETTEVILLE, AR 72702-1523
(479) 571-6038
(479) 582-0222
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
E-6379
AR
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
E-6379
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
E6379
STATE LICENSE
AR
Enumeration date
12/11/2007
Last updated
08/15/2024
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