Provider Demographics
NPI:1518922632
Name:PAUL W DAVIS MD PA
Entity type:Organization
Organization Name:PAUL W DAVIS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:HARMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-879-6791
Mailing Address - Street 1:PO BOX 1225
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71613-1225
Mailing Address - Country:US
Mailing Address - Phone:870-879-6791
Mailing Address - Fax:870-879-4476
Practice Address - Street 1:4747 DUSTY LAKE DR
Practice Address - Street 2:STE G1
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-9056
Practice Address - Country:US
Practice Address - Phone:870-879-6791
Practice Address - Fax:870-879-4476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR111582002Medicaid
AR57130Medicare ID - Type Unspecified