| Paul W Davis Md Pa | |
|
4747 Dusty Lake Dr Ste G1 Pine Bluff AR 71603-9056 | |
| (870) 879-6791 | |
| (870) 879-4476 |
| Full Name | Paul W Davis Md Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 4747 Dusty Lake Dr, Pine Bluff, Arkansas |
| Authorized Official Name and Position | Sandra Kay Harmon (OFFICE MANAGER) |
| Authorized Official Contact | 8708796791 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Paul W Davis Md Pa Po Box 1225 Pine Bluff AR 71613-1225 Ph: (870) 879-6791 | Paul W Davis Md Pa 4747 Dusty Lake Dr Ste G1 Pine Bluff AR 71603-9056 Ph: (870) 879-6791 |
| NPI Number | 1518922632 |
|---|---|
| Provider Enumeration Date | 04/20/2006 |
| Last Update Date | 01/31/2008 |
| Medicare PECOS PAC ID | 1759428840 |
|---|---|
| Medicare Enrollment ID | O20091022000034 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518922632 | NPI | - | NPPES |
| 111582002 | Medicaid | AR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Paul W Davis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1386637221 PECOS PAC ID: 5496839706 Enrollment ID: I20101021000696 |
| Provider Name | Elizabeth Hartz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932879350 PECOS PAC ID: 9234537622 Enrollment ID: I20211015001373 |
| Provider Name | Cacee Raddle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124740428 PECOS PAC ID: 6608243746 Enrollment ID: I20221102003418 |
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