Provider Demographics
NPI:1154306603
Name:PETROS, DAVID P (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:P
Last Name:PETROS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 497
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:AR
Mailing Address - Zip Code:72006-0497
Mailing Address - Country:US
Mailing Address - Phone:870-347-2534
Mailing Address - Fax:
Practice Address - Street 1:1792 E JOYCE BLVD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5253
Practice Address - Country:US
Practice Address - Phone:501-500-5001
Practice Address - Fax:501-500-5008
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0629207RR0500X
ARE-18451207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE96175Medicare UPIN
TX391100ZMFSMedicare PIN
TX86385JMedicare ID - Type Unspecified