Healthcare Provider Details

I. General information

NPI: 1801822432
Provider Name (Legal Business Name): DAVID LEE WADLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 HARRISON ST WHITE RIVER MEDICAL CENTER
BATESVILLE AR
72501-7303
US

IV. Provider business mailing address

1490 BYERS ST
BATESVILLE AR
72501-5831
US

V. Phone/Fax

Practice location:
  • Phone: 870-262-3126
  • Fax: 870-793-8002
Mailing address:
  • Phone: 870-793-2207
  • Fax: 870-793-8002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberC6685
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: