Provider Demographics
NPI:1699778407
Name:AQUILAR, DANNY J (DPM)
Entity type:Individual
Prefix:DR
First Name:DANNY
Middle Name:J
Last Name:AQUILAR
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2089
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72811-2089
Mailing Address - Country:US
Mailing Address - Phone:479-890-3668
Mailing Address - Fax:479-890-9513
Practice Address - Street 1:2400 W MAIN ST
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-2531
Practice Address - Country:US
Practice Address - Phone:479-890-3668
Practice Address - Fax:479-890-9513
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR141213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR139839717Medicaid
AR5375757OtherAETNA INDIVIDUAL NUMBER
AR5U232OtherBCBS INDIVIDUAL NUMBER
AR18514000000OtherQUALCHOICE INDV. NUMBER
AR7396535001OtherCIGNA INDIVIDUAL NUMBER
AR480030569OtherRAILROAD MEDICARE NUMBER
AR5U232OtherBCBS INDIVIDUAL NUMBER
ARU73843Medicare UPIN