Provider Demographics
NPI:1225090962
Name:CARTAYA, DANIEL ISIDRO (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:ISIDRO
Last Name:CARTAYA
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 1:112 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015-3765
Mailing Address - Country:US
Mailing Address - Phone:501-778-5740
Mailing Address - Fax:501-778-5743
Practice Address - Street 1:112 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-3765
Practice Address - Country:US
Practice Address - Phone:501-778-5740
Practice Address - Fax:501-778-5743
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-1813207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5K824Medicare ID - Type Unspecified
G75486Medicare UPIN