Provider Demographics
NPI:1245410216
Name:ANDERSON, DAVID E (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:E
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 456
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72033-0456
Mailing Address - Country:US
Mailing Address - Phone:501-712-1998
Mailing Address - Fax:501-712-1999
Practice Address - Street 1:2525 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-6135
Practice Address - Country:US
Practice Address - Phone:501-712-1998
Practice Address - Fax:501-712-1999
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-07
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-55422084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARE-5542OtherARKANSAS STATE MEDICAL BOARD LICENSE NUMBER
AR5AH85C025Medicare PIN