1275556599 NPI number — DR. DAVID G DAVILA M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275556599 NPI number — DR. DAVID G DAVILA M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

DAVILA

Provider First Name:

DAVID

Provider Middle Name:

G

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1275556599

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

05/15/2008

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

11001 EXECUTIVE CENTER DR

Provider Second Line Business Mailing Address:

SUITE 200

Provider Business Mailing Address City Name:

LITTLE ROCK

Provider Business Mailing Address State Name:

AR

Provider Business Mailing Address Postal Code:

72211-4316

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

501-202-1902

Provider Business Mailing Address Fax Number:

501-202-1512

Provider First Line Business Practice Location Address:

9500 KANIS RD

Provider Second Line Business Practice Location Address:

HICKINGBOTHAM OUTPATIENT CENTER

Provider Business Practice Location Address City Name:

LITTLE ROCK

Provider Business Practice Location Address State Name:

AR

Provider Business Practice Location Address Postal Code:

72205-6324

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

501-202-1902

Provider Business Practice Location Address Fax Number:

501-202-1512

Provider Enumeration Date:

07/26/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207RS0012X , with the licence number:  E0022 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 1275556599 . This is a "MUNICIPAL HEALTH" identifier . This identifiers is of the category "OTHER".
• Identifier: 19675000040 . This is a "QUAL CHOICE" identifier . This identifiers is of the category "OTHER".
• Identifier: 2075612 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 5593044 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 71-0781138 . This is a "AMCO" identifier . This identifiers is of the category "OTHER".
• Identifier: 71-0781138 . This is a "GREAT WEST" identifier . This identifiers is of the category "OTHER".
• Identifier: F002 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 126828801 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
• Identifier: 510810 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".
• Identifier: 5J356 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
• Identifier: 2738596 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 710781138028 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
• Identifier: SPE 0022 . This is a "ARKANSAS COMMUNITY CARE" identifier . This identifiers is of the category "OTHER".