Healthcare Provider Details

I. General information

NPI: 1760580245
Provider Name (Legal Business Name): DAVID RANDAL HUNDLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RANDAL F HUNDLEY M.D.

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 09/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S GAINES ST
LITTLE ROCK AR
72201-4007
US

IV. Provider business mailing address

2423 N FILLMORE ST
LITTLE ROCK AR
72207-3612
US

V. Phone/Fax

Practice location:
  • Phone: 501-378-5623
  • Fax:
Mailing address:
  • Phone: 501-350-2030
  • Fax: 501-421-0105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberN6778
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberN6778
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: