Healthcare Provider Details

I. General information

NPI: 1164401832
Provider Name (Legal Business Name): DAVID A. DIAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EAST MAIN & SOUTH 20TH STREET
VAN BUREN AR
72957
US

IV. Provider business mailing address

PO BOX 403234
ATLANTA GA
30384-3234
US

V. Phone/Fax

Practice location:
  • Phone: 479-474-3401
  • Fax: 479-471-4388
Mailing address:
  • Phone: 800-377-8721
  • Fax: 304-523-2241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberE-3159
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: