Provider Demographics
NPI:1114993763
Name:DANIEL, WILLIAM A (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:A
Last Name:DANIEL
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:PO BOX 757
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:AR
Mailing Address - Zip Code:71711-0757
Mailing Address - Country:US
Mailing Address - Phone:870-836-8101
Mailing Address - Fax:870-837-6833
Practice Address - Street 1:353 CASH RD SW
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:AR
Practice Address - Zip Code:71701-3704
Practice Address - Country:US
Practice Address - Phone:870-836-8101
Practice Address - Fax:870-837-6833
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR2654207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR103654001Medicaid
13284000000OtherQUALCHOICE
AR110072724OtherRAILROAD MEDICARE
AR770008601OtherBREASTCARE
0000209799102OtherUNITED HEALTH CARE
5853130OtherAETNA
AR110072724Medicare PIN
13284000000OtherQUALCHOICE
51275Medicare PIN