Healthcare Provider Details

I. General information

NPI: 1790976488
Provider Name (Legal Business Name): DAVID BRADLEY DAVIS AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2007
Last Update Date: 07/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5910 C ST
LITTLE ROCK AR
72205
US

IV. Provider business mailing address

5910 C ST
LITTLE ROCK AR
72205-3320
US

V. Phone/Fax

Practice location:
  • Phone: 501-476-3178
  • Fax:
Mailing address:
  • Phone: 501-476-3178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number5734
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number4030
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number431
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: