MEDICARE: LEE A. DAVIS, JR, MD, PA

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
1	207RC0000X	Cardiovascular Disease Physician	E2239	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5C879	OTHER	AR	BLUE CROSS CLINIC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659389278
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEE A. DAVIS, JR, MD, PA

Provider Business Mailing Address
First Line	:	7500 DOLLARWAY RD STE 301
Second Line	:
City	:	WHITE HALL
State	:	AR
Zip	:	71602-3084
Country	:	US
Telephone Number	:	870-850-0800
Fax Number	:	870-850-0801

Provider Business Practice Location Address
First Line	:	7500 DOLLARWAY RD STE 301
Second Line	:
City	:	WHITE HALL
State	:	AR
Zip	:	71602-3084
Country	:	US
Telephone Number	:	870-850-0800
Fax Number	:	870-850-0801

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LEE ANDREW DAVIS JR.
Credential	:	M.D.
Telephone Number	:	870-850-0800

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	11/21/2022

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