Provider Demographics
NPI:1104826320
Name:DAVIS, R KEITH JR (MD)
Entity Type:Individual
Prefix:DR
First Name:R
Middle Name:KEITH
Last Name:DAVIS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:SMACKOVER
Mailing Address - State:AR
Mailing Address - Zip Code:71762-0069
Mailing Address - Country:US
Mailing Address - Phone:870-725-3471
Mailing Address - Fax:870-725-3215
Practice Address - Street 1:1400 PERSHING HWY
Practice Address - Street 2:
Practice Address - City:SMACKOVER
Practice Address - State:AR
Practice Address - Zip Code:71762-2300
Practice Address - Country:US
Practice Address - Phone:870-725-3471
Practice Address - Fax:870-725-3215
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE3055207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARA002OtherTRICARE
AR5M036OtherBCBS
AR145479001Medicaid
AR145479001Medicaid
ARH49756Medicare UPIN