Healthcare Provider Details

I. General information

NPI: 1003149493
Provider Name (Legal Business Name): RICHARD K DAVIS MD PLLC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2009
Last Update Date: 09/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 PERSHING HWY
SMACKOVER AR
71762-2300
US

IV. Provider business mailing address

PO BOX 69
SMACKOVER AR
71762-0069
US

V. Phone/Fax

Practice location:
  • Phone: 870-725-3471
  • Fax: 870-725-3215
Mailing address:
  • Phone: 870-725-3471
  • Fax: 870-725-3215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC6398
License Number StateAR

VIII. Authorized Official

Name: DR. RICHARD K DAVIS SR.
Title or Position: SOLE MEMBER
Credential: M.D.
Phone: 870-725-3471