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:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1703 N BUERKLE ST
Mailing Address - Street 2:
Mailing Address - City:STUTTGART
Mailing Address - State:AR
Mailing Address - Zip Code:72160-3153
Mailing Address - Country:US
Mailing Address - Phone:870-673-2511
Mailing Address - Fax:870-673-2518
Practice Address - Street 1:1703 N BUERKLE ST
Practice Address - Street 2:
Practice Address - City:STUTTGART
Practice Address - State:AR
Practice Address - Zip Code:72160-3153
Practice Address - Country:US
Practice Address - Phone:870-673-2511
Practice Address - Fax:870-673-2518
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-4743207X00000X
ARE4743207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR161267001Medicaid
AR0465700001Medicare NSC
AR5N559Medicare PIN