Individual
FIDEL DAVILA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1808 W MAIN ST, RUSSELLVILLE, AR 72801-2724
(479) 222-1299
Mailing address
21726 E HIGHWAY 412, SPRINGDALE, AR 72764-8961
(479) 222-1299
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
F1494
TX
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
E-6583
AR
207RP1001X
Pulmonary Disease Physician
Primary
E-6583
AR
208M00000X
Hospitalist Physician
E-6583
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
105210203
—
TX
05
—
105210204
—
TX
05
—
105210205
—
TX
Enumeration date
10/10/2007
Last updated
04/24/2017
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