Davis, Randall B

Davis, Randall B is an individual health care provider with primary practice located at 1100 N College Ave , Fayetteville AR 72703-1944. He recently has 2 registered licenses in different health care specialties including Other Service Providers / Specialist, Allopathic & Osteopathic Physicians / Otolaryngology. Allopathic & Osteopathic Physicians / Otolaryngology is his primary health care specialty. Davis, Randall B can be contacted via phone (615) 355-3451.

Contact Information

Primary practice address
1100 N College Ave Fayetteville AR 72703-1944
Phone: (615) 355-3451
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X R3860 Arkansas
Allopathic & Osteopathic Physicians / Otolaryngology 207Y00000X R-3860 Arkansas

Profile Details

NPI number 1265435697
LBN Legal business name Davis, Randall B
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 31st, 2005
Last updated Sep 20th, 2019 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1265435697 NPPES
Arkansas MEDICAID 114745001

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