Provider Demographics
NPI:1477977171
Name:DAVID ANDERSON, MD, PLLC
Entity type:Organization
Organization Name:DAVID ANDERSON, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-712-1998
Mailing Address - Street 1:PO BOX 13805
Mailing Address - Street 2:
Mailing Address - City:MAUMELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72113-0805
Mailing Address - Country:US
Mailing Address - Phone:501-712-1998
Mailing Address - Fax:501-712-1999
Practice Address - Street 1:501 MILLWOOD CIR
Practice Address - Street 2:SUITE H
Practice Address - City:MAUMELLE
Practice Address - State:AR
Practice Address - Zip Code:72113-6327
Practice Address - Country:US
Practice Address - Phone:501-712-1998
Practice Address - Fax:501-712-1999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-15
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARMC-3010OtherARKANSAS STATE MEDICAL BOARD REGISTRATION