Provider Demographics
NPI:1851340939
Name:COSS, DAVID M (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:COSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:904 HOLIDAY DR
Mailing Address - Street 2:SUITE 404
Mailing Address - City:FORREST CITY
Mailing Address - State:AR
Mailing Address - Zip Code:72335-9183
Mailing Address - Country:US
Mailing Address - Phone:870-630-1683
Mailing Address - Fax:870-630-0308
Practice Address - Street 1:904 HOLIDAY DR
Practice Address - Street 2:SUITE 404
Practice Address - City:FORREST CITY
Practice Address - State:AR
Practice Address - Zip Code:72335-9183
Practice Address - Country:US
Practice Address - Phone:870-630-1683
Practice Address - Fax:870-630-0308
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE-3890207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
04030012800OtherQUALCHOICE OF ARKANSAS
LA1742236Medicaid
AR5M781OtherBLUE CROSS BLUE SHIELD
300800OtherCIGNA HEALTH CARE
AR5M781Medicare ID - Type Unspecified
LA1742236Medicaid
I00756Medicare UPIN