Provider Demographics
NPI:1154419356
Name:ATWOOD, H DANIEL (MD)
Entity type:Individual
Prefix:
First Name:H
Middle Name:DANIEL
Last Name:ATWOOD
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 1:1794 E JOYCE BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-5256
Mailing Address - Country:US
Mailing Address - Phone:479-443-7771
Mailing Address - Fax:479-443-7790
Practice Address - Street 1:1794 E JOYCE BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5256
Practice Address - Country:US
Practice Address - Phone:479-443-7771
Practice Address - Fax:479-443-7790
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR3739174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARC68220Medicare UPIN
AR51563Medicare ID - Type Unspecified
51563B984Medicare PIN