Healthcare Provider Details

I. General information

NPI: 1780688309
Provider Name (Legal Business Name): RONALD CRAIG DAVIS M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

Provider Other Name: CRAIG DAVIS M.D.

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W 16TH ST STE B
HOPE AR
71801-7104
US

IV. Provider business mailing address

PO BOX 785
HOPE AR
71802-0785
US

V. Phone/Fax

Practice location:
  • Phone: 870-777-7581
  • Fax: 870-777-4625
Mailing address:
  • Phone: 870-777-7581
  • Fax: 870-777-4625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberC-5391
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: