Organization
RIDGELINE OBSTETRICS & GYNECOLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WALTER L DAVIS M.D. (SOLE MEMBER)
(870) 633-0712
Entity
Organization
Contact information
Practice address
1601 NEW CASTLE RD, FORREST CITY, AR 72335-2218
(870) 633-0712
Mailing address
PO BOX 705, FORREST CITY, AR 72336-0705
(870) 633-0712
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
E5242
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5N992
BCBS PROVIDER NUMBER
AR
Enumeration date
07/10/2009
Last updated
07/13/2009
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