Provider Demographics
NPI:1598707754
Name:KLEIN, DANIEL BARRY (DPM)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:BARRY
Last Name:KLEIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 ROGERS AVE
Mailing Address - Street 2:STE B
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903
Mailing Address - Country:US
Mailing Address - Phone:479-484-6717
Mailing Address - Fax:479-484-9648
Practice Address - Street 1:9000 ROGERS AVE
Practice Address - Street 2:STE B
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903
Practice Address - Country:US
Practice Address - Phone:479-484-6717
Practice Address - Fax:479-484-9648
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR144213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR139382717Medicaid
1598707754OtherSOLE PROPIETOR NPI
1251590001Medicare NSC
51426Medicare UPIN
AR5S854Medicare PIN