Healthcare Provider Details

I. General information

NPI: 1417301417
Provider Name (Legal Business Name): SHAUN DANIEL ADAMS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2016
Last Update Date: 08/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 S RIFE MEDICAL LN
ROGERS AR
72758-1452
US

IV. Provider business mailing address

1341 N FUTRALL DR APARTMENT 4
FAYETTEVILLE AR
72703-1172
US

V. Phone/Fax

Practice location:
  • Phone: 479-338-8000
  • Fax:
Mailing address:
  • Phone: 501-626-4477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberE-12093
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: