MEDICARE: D&D DOCTORS PLLC

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
1	207QG0300X	Geriatric Medicine (Family Medicine) Physician	E4008	AR
2	207Q00000X	Family Medicine Physician	E4008	AR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	5N254	OTHER	AR	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831626183
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	D&D DOCTORS PLLC

Provider Business Mailing Address
First Line	:	20602 ARCH STREET PIKE
Second Line	:
City	:	HENSLEY
State	:	AR
Zip	:	72065-9442
Country	:	US
Telephone Number	:	347-851-0116
Fax Number	:	501-891-5672

Provider Business Practice Location Address
First Line	:	20602 ARCH STREET PIKE
Second Line	:
City	:	HENSLEY
State	:	AR
Zip	:	72065-9442
Country	:	US
Telephone Number	:	347-851-0116
Fax Number	:	501-891-5672

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	SANJAY R DASS
Credential	:	MD
Telephone Number	:	501-626-0053

Provider Enumeration Date	:	05/17/2017
Last Update Date	:	07/09/2024

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Directions to “D&D DOCTORS PLLC ” Practice Location

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