Healthcare Provider Details

I. General information

NPI: 1821057480
Provider Name (Legal Business Name): DAVID LYNN WASSELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1703 N BUERKLE ST
STUTTGART AR
72160-3153
US

IV. Provider business mailing address

1703 N BUERKLE ST
STUTTGART AR
72160-3153
US

V. Phone/Fax

Practice location:
  • Phone: 870-673-2511
  • Fax: 870-673-2518
Mailing address:
  • Phone: 870-673-2511
  • Fax: 870-673-2518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberE-4743
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberE4743
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: