Provider Demographics
NPI:1265675854
Name:ARSENAULT, DANIEL MICHAEL JR (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:MICHAEL
Last Name:ARSENAULT
Suffix:JR
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 2533
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79105-2533
Mailing Address - Country:US
Mailing Address - Phone:806-359-4673
Mailing Address - Fax:806-356-1901
Practice Address - Street 1:1500 WALLACE BLVD
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1794
Practice Address - Country:US
Practice Address - Phone:806-359-4673
Practice Address - Fax:806-356-1901
Is Sole Proprietor?:No
Enumeration Date:2009-04-12
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP99972085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX340327101Medicaid
TX356892YM5UMedicare PIN