Provider Demographics
NPI:1770566796
Name:DAVIS, JEREMY C (MD)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:C
Last Name:DAVIS
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 1:409 N UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-3108
Mailing Address - Country:US
Mailing Address - Phone:501-664-6980
Mailing Address - Fax:501-664-4738
Practice Address - Street 1:409 N UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-3108
Practice Address - Country:US
Practice Address - Phone:501-664-6980
Practice Address - Fax:501-664-4738
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE5313207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine