Provider Demographics
NPI:1760580245
Name:HUNDLEY, DAVID RANDAL (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RANDAL
Last Name:HUNDLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RANDAL
Other - Middle Name:F
Other - Last Name:HUNDLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2423 N FILLMORE ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72207-3612
Mailing Address - Country:US
Mailing Address - Phone:501-350-2030
Mailing Address - Fax:501-421-0105
Practice Address - Street 1:601 S GAINES ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72201-4007
Practice Address - Country:US
Practice Address - Phone:501-378-5623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARN6778207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR89-T031OtherMALP INS
AR109935001Medicaid
AR52519Medicare ID - Type Unspecified
AR109935001Medicaid