Provider Demographics
NPI:1780688309
Name:DAVIS, RONALD CRAIG (MS)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:CRAIG
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MS
Other - Prefix:DR
Other - First Name:CRAIG
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 785
Mailing Address - Street 2:
Mailing Address - City:HOPE
Mailing Address - State:AR
Mailing Address - Zip Code:71802-0785
Mailing Address - Country:US
Mailing Address - Phone:870-777-7581
Mailing Address - Fax:870-777-4625
Practice Address - Street 1:405 W 16TH ST
Practice Address - Street 2:STE B
Practice Address - City:HOPE
Practice Address - State:AR
Practice Address - Zip Code:71801-7104
Practice Address - Country:US
Practice Address - Phone:870-777-7581
Practice Address - Fax:870-777-4625
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-5391174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR51318OtherBCBS PROVIDER NUMBER
AR51318OtherBCBS PROVIDER NUMBER