Healthcare Provider Details

I. General information

NPI: 1518922632
Provider Name (Legal Business Name): PAUL W DAVIS MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 01/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4747 DUSTY LAKE DR STE G1
PINE BLUFF AR
71603-9056
US

IV. Provider business mailing address

PO BOX 1225
PINE BLUFF AR
71613-1225
US

V. Phone/Fax

Practice location:
  • Phone: 870-879-6791
  • Fax: 870-879-4476
Mailing address:
  • Phone: 870-879-6791
  • Fax: 870-879-4476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. SANDRA KAY HARMON
Title or Position: OFFICE MANAGER
Credential:
Phone: 870-879-6791