Provider Demographics
NPI:1538141155
Name:COOPER, DANIEL HUNT (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:HUNT
Last Name:COOPER
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 1251
Mailing Address - Street 2:
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-1251
Mailing Address - Country:US
Mailing Address - Phone:918-422-4102
Mailing Address - Fax:918-422-4093
Practice Address - Street 1:1101 JACKSON ST SW
Practice Address - Street 2:
Practice Address - City:GRAVETTE
Practice Address - State:AR
Practice Address - Zip Code:72736-9121
Practice Address - Country:US
Practice Address - Phone:479-787-5291
Practice Address - Fax:479-344-6404
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC8243207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5K295OtherBC/BS
ARC8243OtherLICENCE #
AR130607001Medicaid
OK100159060AMedicaid
OK100159060AMedicaid
AR5K295Medicare PIN
OK100159060AMedicaid