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NPI Code Detail

MEDICARE: MR. RONALD F DAVIS MEDICAL DIANOSTIC TE

MEDICARE: MR. RONALD F DAVIS MEDICAL DIANOSTIC TE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235500000XSpeech/Language/Hearing Specialist/Technologist

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
256C52OTHERARMEDICARE ID

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15C724OTHERARIDTF

General Provider Information

NPI Number : 1396845574
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RONALD F DAVIS MEDICAL DIANOSTIC TE
Provider Business Mailing Address
First Line : 2227 WEST MAIN ST
Second Line :
City : JACKSONVILLE
State : AR
Zip : 72076-4207
Country : US
Telephone Number : 501-985-9944
Fax Number : 501-985-6590
Provider Business Practice Location Address
First Line : 2227 W MAIN ST
Second Line :
City : JACKSONVILLE
State : AR
Zip : 72076-4207
Country : US
Telephone Number : 501-985-9944
Fax Number : 501-985-6590
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/25/2006
Last Update Date : 07/25/2007

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