Healthcare Provider Details

I. General information

NPI: 1851340939
Provider Name (Legal Business Name): DAVID M COSS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 HOLIDAY DR SUITE 404
FORREST CITY AR
72335-9183
US

IV. Provider business mailing address

904 HOLIDAY DR SUITE 404
FORREST CITY AR
72335-9183
US

V. Phone/Fax

Practice location:
  • Phone: 870-630-1683
  • Fax: 870-630-0308
Mailing address:
  • Phone: 870-630-1683
  • Fax: 870-630-0308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE-3890
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: