Provider Demographics
NPI:1316963234
Name:DANIEL, AMY M (MD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:M
Last Name:DANIEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:205 WESTPORT DR STE 1
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-3657
Mailing Address - Country:US
Mailing Address - Phone:501-843-6585
Mailing Address - Fax:501-843-2380
Practice Address - Street 1:205 WESTPORT DR STE 1
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023
Practice Address - Country:US
Practice Address - Phone:501-843-6585
Practice Address - Fax:501-843-2380
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE4364207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR158459001Medicaid
I44400Medicare UPIN
AR5N250Medicare PIN
AR158459001Medicaid
AR57297Medicare PIN