Provider Demographics
NPI:1518584077
Name:DAVIS, ROBERT RAY
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:RAY
Last Name:DAVIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1519 MULBERRY SALEM RD
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72019-8253
Mailing Address - Country:US
Mailing Address - Phone:501-293-2638
Mailing Address - Fax:
Practice Address - Street 1:1519 MULBERRY SALEM RD
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72019-8253
Practice Address - Country:US
Practice Address - Phone:501-293-2638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-01
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider