Individual
CHARLES D DAVIDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1210 W MAIN ST, WALNUT RIDGE, AR 72476-1005
(870) 886-3543
(870) 886-3252
Mailing address
PO BOX 719, WALNUT RIDGE, AR 72476-0719
(870) 886-3543
(870) 886-3252
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
N8263
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
55949
BLUE CROSS BLUE SHIELD
AR
Enumeration date
11/17/2006
Last updated
07/08/2007
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