Provider Demographics
NPI:1093076184
Name:SMALL, DAVID EARL JR (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:EARL
Last Name:SMALL
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-316-5080
Mailing Address - Fax:704-316-5085
Practice Address - Street 1:5815 BLAKENEY PARK DR
Practice Address - Street 2:SUITE 200
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-5731
Practice Address - Country:US
Practice Address - Phone:704-316-5080
Practice Address - Fax:704-316-5085
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2020-10-25
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Provider Licenses
StateLicense IDTaxonomies
NC183546207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine