Organization
SOUTH ARK EAR NOSE &THROAT CLINIC P A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN DONALD SHORTS MD (PRESIDENT)
(870) 535-5719
Entity
Organization
Contact information
Practice address
1722 W 42ND AVE, PINE BLUFF, AR 71603-7008
(870) 535-5719
(870) 536-1963
Mailing address
1722 W 42ND AVE, PINE BLUFF, AR 71603-7008
(870) 535-5719
(870) 536-1963
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
MC1312
AR
207KA0200X
Allergy Physician
MC1312
AR
207Y00000X
Otolaryngology Physician
Primary
MC1312
AR
231H00000X
Audiologist
A#283
AR
237600000X
Audiologist-Hearing Aid Fitter
A#283
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103005702
—
AR
05
—
142932720
—
AR
01
—
56924
ARKANSAS BLUE CROSS BLUE SHIELD
AR
Enumeration date
02/27/2006
Last updated
04/30/2019
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