Provider Demographics
NPI:1770582041
Name:SHIRLEY, DAVID CRAIG (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CRAIG
Last Name:SHIRLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:495 HOGAN LANE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034
Mailing Address - Country:US
Mailing Address - Phone:501-327-5850
Mailing Address - Fax:501-327-4910
Practice Address - Street 1:495 HOGAN LANE
Practice Address - Street 2:SUITE 2
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034
Practice Address - Country:US
Practice Address - Phone:501-327-5850
Practice Address - Fax:501-327-4910
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARN-7212208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR113501001Medicaid
ARB90095Medicare UPIN
AR113501001Medicaid