Basic Information
| Provider Information | |||||||||
| NPI: | 1831199884 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STOUGH | ||||||||
| FirstName: | DOWLING | ||||||||
| MiddleName: | BLUFORD | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | IV | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3633 CENTRAL AVE | ||||||||
| Address2: | STE N | ||||||||
| City: | HOT SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719136404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016236100 | ||||||||
| FaxNumber: | 5016236187 | ||||||||
| Practice Location | |||||||||
| Address1: | 3633 CENTRAL AVE | ||||||||
| Address2: | STE N | ||||||||
| City: | HOT SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719136404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016236100 | ||||||||
| FaxNumber: | 5016236187 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2005 | ||||||||
| LastUpdateDate: | 09/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | C6673 | AR | Y | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | 115184001 | 05 | AR | MEDICAID |