Healthcare Provider Details

I. General information

NPI: 1407374101
Provider Name (Legal Business Name): R KEITH DAVIS MD PLLC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2017
Last Update Date: 09/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 BUCKAROO LN
SMACKOVER AR
71762-1730
US

IV. Provider business mailing address

1400 PERSHING HWY
SMACKOVER AR
71762-2300
US

V. Phone/Fax

Practice location:
  • Phone: 870-725-3471
  • Fax: 870-725-3041
Mailing address:
  • Phone: 870-725-3471
  • Fax: 870-725-3041

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: RICHARD KEITH DAVIS JR.
Title or Position: OWNER
Credential: MD
Phone: 870-725-3471