=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902950116
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAVID W FURR LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2007
-----------------------------------------------------
Last Update Date | 10/15/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 307 E RAY FINE BLVD
-----------------------------------------------------
City | ROLAND
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74954-5160
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-427-3760
-----------------------------------------------------
Fax | 918-427-0081
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 11407
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35246-1555
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-427-3760
-----------------------------------------------------
Fax | 918-427-0081
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN OWNER
-----------------------------------------------------
Name | DR. DAVID WAYNE FURR
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 479-420-6618
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | E-3777
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 3855
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------