Provider Demographics
NPI:1447257597
Name:DAVIDSON, DENNIS O (MD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:O
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:701 N UNIVERSITY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205
Mailing Address - Country:US
Mailing Address - Phone:501-224-1690
Mailing Address - Fax:501-224-1927
Practice Address - Street 1:2000 HARRISON ST
Practice Address - Street 2:SUITE D
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501
Practice Address - Country:US
Practice Address - Phone:870-793-4724
Practice Address - Fax:870-793-4725
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2008-04-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ARC4467207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1670586OtherUNITED HEALTHCARE
AR13600000000OtherQUAL CHOICE
AR51298Medicare PIN
AR1670586OtherUNITED HEALTHCARE