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General NPI Number Information
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NPI Number | 1679576631
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Entity Type | Individual
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Provider Name | DAVID ARTHUR DIFFINE MD
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Gender | Male
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Dates
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Enumeration Date | 05/24/2005
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Last Update Date | 02/07/2024
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Provider Practice Location Address
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Address Line | 1100 MEDICAL DR SUITE C
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City | BLYTHEVILLE
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State | AR
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Zip | 72315-1425
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Country | US
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Telephone | 870-824-2809
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Fax | 870-762-0731
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Provider Business Mailing Address
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Address Line | 1100 MEDICAL DR SUITE C
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City | BLYTHEVILLE
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State | AR
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Zip | 72315-1425
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Country | US
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Telephone | 870-824-2809
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Fax | 870-762-0731
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2000148413
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | E-3767
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License Number State | AR
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