Provider Demographics
NPI:1407374101
Name:R KEITH DAVIS MD PLLC PA
Entity Type:Organization
Organization Name:R KEITH DAVIS MD PLLC PA
Other - Org Name:R KEITH DAVIS MD PLLC PA SCHOOL BASED CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:870-725-3471
Mailing Address - Street 1:1400 PERSHING HWY
Mailing Address - Street 2:
Mailing Address - City:SMACKOVER
Mailing Address - State:AR
Mailing Address - Zip Code:71762-2300
Mailing Address - Country:US
Mailing Address - Phone:870-725-3471
Mailing Address - Fax:870-725-3041
Practice Address - Street 1:727 BUCKAROO LN
Practice Address - Street 2:
Practice Address - City:SMACKOVER
Practice Address - State:AR
Practice Address - Zip Code:71762-1730
Practice Address - Country:US
Practice Address - Phone:870-725-3471
Practice Address - Fax:870-725-3041
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:R.KEITH DAVIS MD PLLC PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-09-01
Last Update Date:2017-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty