Provider Demographics
NPI:1962515668
Name:CARROUTH, DAVID AARON (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:AARON
Last Name:CARROUTH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1600 W 40TH AVE
Mailing Address - Street 2:C/O BRENNA WOODRUFF
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-6301
Mailing Address - Country:US
Mailing Address - Phone:870-541-7220
Mailing Address - Fax:870-541-7406
Practice Address - Street 1:1600 W 40TH AVE
Practice Address - Street 2:C/O BRENNA WOODRUFF
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-6301
Practice Address - Country:US
Practice Address - Phone:870-541-7220
Practice Address - Fax:870-541-7406
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AR4825207R00000X
TXP2606207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR201740001Medicaid
AR5UU60OtherBCBS