Healthcare Provider Details

I. General information

NPI: 1508812850
Provider Name (Legal Business Name): GLORIA RICHARD-DAVIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 08/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 W MARKHAM ST # 783
LITTLE ROCK AR
72205-7101
US

IV. Provider business mailing address

4301 W MARKHAM ST DEPARTMENT OF OB/GYN
LITTLE ROCK AR
72205-7101
US

V. Phone/Fax

Practice location:
  • Phone: 501-614-2006
  • Fax: 501-526-6562
Mailing address:
  • Phone: 501-296-1099
  • Fax: 501-686-8091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD.016683
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberE-7844
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: