Provider Demographics
NPI:1255626602
Name:WHITELOCKE, DANIEL ADRIAN (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ADRIAN
Last Name:WHITELOCKE
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 1:1404 W CENTENNIAL DR
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-5763
Mailing Address - Country:US
Mailing Address - Phone:901-649-8755
Mailing Address - Fax:
Practice Address - Street 1:402 S LEE ST
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:AR
Practice Address - Zip Code:71744-8615
Practice Address - Country:US
Practice Address - Phone:870-798-4064
Practice Address - Fax:870-798-4100
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ARE8491207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program