MEDICARE: DR. PETER M DAUT M.D.

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	207W00000X	Ophthalmology Physician	E4319	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11810000000	OTHER	AR	QUALCHOICE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	5N242	OTHER	AR	BLUE CROSS PROVIDER

General Provider Information

NPI Number	:	1952352106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER M DAUT M.D.

Provider Business Mailing Address
First Line	:	741 E VAN ASCHE DR
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72703-4916
Country	:	US
Telephone Number	:	479-442-5227
Fax Number	:	479-582-4952

Provider Business Practice Location Address
First Line	:	741 E VAN ASCHE DR
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72703
Country	:	US
Telephone Number	:	479-442-5227
Fax Number	:	479-582-4952

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	06/25/2025

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Directions to “ DR. PETER M DAUT M.D.” Practice Location

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