Provider Demographics
NPI:1881747046
Name:DREW, DANNY ELLIOTT (MD)
Entity type:Individual
Prefix:
First Name:DANNY
Middle Name:ELLIOTT
Last Name:DREW
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:DANIEL
Other - Middle Name:ELLIOTT
Other - Last Name:DREW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:614 E EMMA AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-4469
Mailing Address - Country:US
Mailing Address - Phone:479-751-7417
Mailing Address - Fax:
Practice Address - Street 1:614 E EMMA AVE STE 300
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-4469
Practice Address - Country:US
Practice Address - Phone:479-751-7417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA98440207Q00000X
ORMD152952207Q00000X
ARE-18570207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A984400OtherMEDICARE
ORR15844OtherMEDICARE -PTAN