Healthcare Provider Details

I. General information

NPI: 1942244090
Provider Name (Legal Business Name): RICHARD E DAILY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 07/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 RIMROCK RD
RUSSELLVILLE AR
72802-8878
US

IV. Provider business mailing address

16 RIMROCK RD
RUSSELLVILLE AR
72802-8878
US

V. Phone/Fax

Practice location:
  • Phone: 479-747-3582
  • Fax: 866-716-7912
Mailing address:
  • Phone: 479-747-3582
  • Fax: 866-716-7912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberR6D60
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberC-5537
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number15999
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: