Provider Demographics
NPI:1073700167
Name:DR. WENDY DAVID INTERNAL MEDICINE CLINIC, PLLC
Entity Type:Organization
Organization Name:DR. WENDY DAVID INTERNAL MEDICINE CLINIC, PLLC
Other - Org Name:WD MD INTERNAL MEDICINE AND HEART CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-273-9700
Mailing Address - Street 1:P.O. BOX 16871
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72403-6714
Mailing Address - Country:US
Mailing Address - Phone:479-273-9700
Mailing Address - Fax:479-273-9706
Practice Address - Street 1:701 HORSEBARN RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758
Practice Address - Country:US
Practice Address - Phone:479-273-9700
Practice Address - Fax:479-273-9706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE0168174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR125865001Medicaid
ARBB2262436OtherDEA NUMBER
AR125865001Medicaid
ARBB2262436OtherDEA NUMBER