Healthcare Provider Details

I. General information

NPI: 1609261338
Provider Name (Legal Business Name): DANIEL LEE PRICE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2015
Last Update Date: 06/01/2022
Certification Date: 06/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 COURT ST STE 9
CONWAY AR
72032-5417
US

IV. Provider business mailing address

PO BOX 2125
BENTON AR
72018-2125
US

V. Phone/Fax

Practice location:
  • Phone: 501-205-4570
  • Fax:
Mailing address:
  • Phone: 501-205-4570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberE-11941
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: