Provider Demographics
NPI:1720082530
Name:PERSSON, DAVID M (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:PERSSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21850
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71903-1850
Mailing Address - Country:US
Mailing Address - Phone:501-922-1700
Mailing Address - Fax:
Practice Address - Street 1:410 PONCE DE LEON DR
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS VILLAGE
Practice Address - State:AR
Practice Address - Zip Code:71909-8121
Practice Address - Country:US
Practice Address - Phone:501-922-1700
Practice Address - Fax:501-922-0826
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11939R207R00000X
LAMD.11939R207R00000X
ARE-11147207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX060967902Medicaid
TX060967901Medicaid
LA1684945Medicaid
AR181385001Medicaid
LAB07838Medicare UPIN
TX060967902Medicaid
TX060967902Medicaid
LAP00818517Medicare PIN
LA5Y059CQ62Medicare PIN