Provider Demographics
NPI:1639259450
Name:DAVIS, GREGORY W (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:W
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2301 S 56TH ST, SUITE 110
Mailing Address - Street 2:P O BOX 11880
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72917-1880
Mailing Address - Country:US
Mailing Address - Phone:479-452-1581
Mailing Address - Fax:479-452-2148
Practice Address - Street 1:2301 S 56TH ST,
Practice Address - Street 2:SUITE 110
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-3710
Practice Address - Country:US
Practice Address - Phone:479-452-1581
Practice Address - Fax:479-452-2148
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2012-05-09
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Provider Licenses
StateLicense IDTaxonomies
ARN8315207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR122330001Medicaid
AR55944Medicare PIN