Healthcare Provider Details

I. General information

NPI: 1154346294
Provider Name (Legal Business Name): L DANIEL EATON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 01/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 N VAN BUREN ST
LITTLE ROCK AR
72205-3650
US

IV. Provider business mailing address

220 N VAN BUREN ST
LITTLE ROCK AR
72205-3650
US

V. Phone/Fax

Practice location:
  • Phone: 501-265-0100
  • Fax: 501-265-0102
Mailing address:
  • Phone: 501-265-0100
  • Fax: 501-265-0102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number84-189-08
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: