Individual
DAVID M STREET
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2010 ACTIVE WAY, BENTON, AR 72022-9267
(501) 315-0984
(501) 847-1405
Mailing address
2010 ACTIVE WAY, BENTON, AR 72022-9267
(501) 315-0984
(501) 847-1405
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PT2020058
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT2020-058
ARKANSAS STATE LICENSE
AR
Enumeration date
10/09/2020
Last updated
10/09/2020
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