Individual
ROYCE ALLAN STANFORD JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2301 SPRINGHILL RD, SUITE 200, BENTON, AR 72015-7552
(501) 315-0078
(501) 943-3016
Mailing address
2301 SPRINGHILL RD, SUITE 200, BENTON, AR 72015-7552
(501) 315-0078
(501) 943-3016
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
C-5980
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
105904001
—
AR
01
—
11300000000
QUALCHOICE PROVIDER ID
AR
01
—
1220097
UNITED HEALTHCARE PROV #
AR
01
—
4203731
AETNA PROVIDER ID
AR
01
—
55089
BCBS NUMBER
AR
Enumeration date
04/03/2006
Last updated
01/07/2011
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