Provider Demographics
NPI:1790860716
Name:OBERLANDER, DAVID ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALLEN
Last Name:OBERLANDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 11078
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-0019
Mailing Address - Country:US
Mailing Address - Phone:501-860-6130
Mailing Address - Fax:501-860-6054
Practice Address - Street 1:400 SALEM RD
Practice Address - Street 2:BLDG 3 SUITE 1
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-6162
Practice Address - Country:US
Practice Address - Phone:501-505-0400
Practice Address - Fax:501-505-0402
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE17482084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1344820001Medicaid
AZF89073Medicare UPIN
AR1344820001Medicaid