Provider Demographics
NPI:1912960519
Name:MCDANIEL, CRAIG A (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:A
Last Name:MCDANIEL
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 1:3104 APACHE DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-7405
Mailing Address - Country:US
Mailing Address - Phone:870-932-2499
Mailing Address - Fax:870-932-2401
Practice Address - Street 1:2205 W PARKER RD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72404-7778
Practice Address - Country:US
Practice Address - Phone:870-933-9250
Practice Address - Fax:870-931-4790
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-5926207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR103146001Medicaid
AR103146001Medicaid
ARD04771Medicare UPIN