Healthcare Provider Details

I. General information

NPI: 1841260122
Provider Name (Legal Business Name): DANIEL W. WATSON M. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 12/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 AUTUMN RD SUITE 200
LITTLE ROCK AR
72211-3737
US

IV. Provider business mailing address

904 AUTUMN RD SUITE 200
LITTLE ROCK AR
72211-3737
US

V. Phone/Fax

Practice location:
  • Phone: 501-227-6363
  • Fax: 501-227-8629
Mailing address:
  • Phone: 501-227-6363
  • Fax: 501-227-8629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC6896
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: