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NPI Code Detail

MEDICARE: DANIEL DILLARD MD

MEDICARE: DANIEL DILLARD MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianC4472AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
151379OTHERARBLUE CROSS BLUE SHIELD
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3120025OTHERARUNITED HEALTHCARE
411114000000OTHERARQUALCHOICE

General Provider Information

NPI Number : 1477550093
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANIEL DILLARD MD
Provider Business Mailing Address
First Line : 4202 S UNIVERSITY AVE
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72204-7841
Country : US
Telephone Number : 501-562-4838
Fax Number : 501-562-1958
Provider Business Practice Location Address
First Line : 4202 S UNIVERSITY AVE
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72204-7841
Country : US
Telephone Number : 501-562-4838
Fax Number : 501-562-1958
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/29/2005
Last Update Date : 02/21/2012

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Directions to “ DANIEL DILLARD MD” Practice Location

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