Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0011X | Interventional Cardiology | C6809 | AR |
NPI | 1023072808 |
---|---|
Provider Name | Dr. David A Churchill |
First Address | Fayetteville, AR 72703-4007 |
Second Address | Fayetteville, AR 72703-4007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2006 |
Last Update Date | 28/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100077630A | (05) | OK |
111127001 | (05) | AR |
122050000 | QUALCHOICE (01) | AR |
1670494 | UNITED HEALTHCARE (01) | AR |
204813000 | (05) | MO |
4567131 | AETNA (01) | AR |
A023 | CHAMPUS (01) | AR |
AC3145845 | DEA (01) | AR |
C67740 | (02) | AR |
C6809 | STATE LICENSE (01) | AR |