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General NPI Number Information
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NPI Number | 1306805379
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Entity Type | Individual
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Provider Name | DANNY L PROFFITT M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/20/2006
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Last Update Date | 12/07/2018
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Provider Practice Location Address
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Address Line | 934 NORTH GASKILL
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City | HUNTSVILLE
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State | AR
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Zip | 72740-1319
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Country | US
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Telephone | 479-738-5500
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Fax | 479-738-1350
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Provider Business Mailing Address
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Address Line | PO BOX 1060
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City | MARSHALL
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State | AR
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Zip | 72650-1060
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Country | US
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Telephone | 870-448-5101
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Fax | 870-448-3767
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | C-5443
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License Number State | AR
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