MEDICARE: DR. MICHAEL DOUGLAS DAVIS JR. D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	E-12166	AR
2	208M00000X	Hospitalist Physician	E-12166	AR

General Provider Information

NPI Number	:	1063866135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL DOUGLAS DAVIS JR. D.O.

Provider Business Mailing Address
First Line	:	7310 PALM BEACH AVE
Second Line	:
City	:	BENTON
State	:	AR
Zip	:	72019-1849
Country	:	US
Telephone Number	:	501-507-2324
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 MEDICAL PARK DR STE 304
Second Line	:
City	:	BENTON
State	:	AR
Zip	:	72015-3745
Country	:	US
Telephone Number	:	501-507-2324
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2016
Last Update Date	:	03/29/2023

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Directions to “ DR. MICHAEL DOUGLAS DAVIS JR. D.O.” Practice Location

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