Healthcare Provider Details

I. General information

NPI: 1255626602
Provider Name (Legal Business Name): DANIEL ADRIAN WHITELOCKE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2011
Last Update Date: 07/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 S LEE ST
HAMPTON AR
71744-8615
US

IV. Provider business mailing address

1404 W CENTENNIAL DR
ROGERS AR
72758-5763
US

V. Phone/Fax

Practice location:
  • Phone: 870-798-4064
  • Fax: 870-798-4100
Mailing address:
  • Phone: 901-649-8755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE8491
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: