Provider Demographics
NPI:1063866135
Name:DAVIS, MICHAEL DOUGLAS JR (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DOUGLAS
Last Name:DAVIS
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7310 PALM BEACH AVE
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72019-1849
Mailing Address - Country:US
Mailing Address - Phone:501-507-2324
Mailing Address - Fax:
Practice Address - Street 1:5 MEDICAL PARK DR STE 304
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-3745
Practice Address - Country:US
Practice Address - Phone:501-507-2324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-14
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-12166207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine