Provider Demographics
NPI:1053424515
Name:BURNS, STANLEY C (MD)
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:C
Last Name:BURNS
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 1:4509 E MCCAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72117-2902
Mailing Address - Country:US
Mailing Address - Phone:501-945-4200
Mailing Address - Fax:501-945-0906
Practice Address - Street 1:4509 E MCCAIN BLVD
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-2902
Practice Address - Country:US
Practice Address - Phone:501-945-4200
Practice Address - Fax:501-945-0906
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARN-5900207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARC67916Medicare UPIN
AR50786Medicare ID - Type Unspecified