Provider Demographics
NPI:1821057480
Name:WASSELL, DAVID LYNN (MD)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:LYNN
Last Name:WASSELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:10301 KANIS RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6205
Mailing Address - Country:US
Mailing Address - Phone:501-604-6900
Mailing Address - Fax:501-604-3220
Practice Address - Street 1:10301 KANIS RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6205
Practice Address - Country:US
Practice Address - Phone:501-604-6900
Practice Address - Fax:501-604-3220
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE4743207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARI59049Medicare UPIN
AR0465700001Medicare NSC
AR5N559Medicare PIN