Provider Demographics
NPI:1083664890
Name:SPRINGER, DAN J (MD)
Entity Type:Individual
Prefix:DR
First Name:DAN
Middle Name:J
Last Name:SPRINGER
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 1:451 S HOLLY ST
Mailing Address - Street 2:
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-3018
Mailing Address - Country:US
Mailing Address - Phone:479-524-3141
Mailing Address - Fax:479-524-3090
Practice Address - Street 1:451 S HOLLY ST
Practice Address - Street 2:
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761-3018
Practice Address - Country:US
Practice Address - Phone:479-524-3141
Practice Address - Fax:479-524-3090
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR3707207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR51536OtherBCBS AR
AR5H484G180OtherMEDICARE FOR SILOAM SPRINGS CLINIC COMPANY LLC
OK731548933001OtherBCBS OK
OK100080430AMedicaid
AR113555001Medicaid
AR113555001Medicaid
OK731548933001OtherBCBS OK
AR080129185Medicare ID - Type UnspecifiedRR MEDICARE AR