1497756076 NPI number — DARIO M ESPINA M.D., F.A.C.C.

Table of content: DARIO M ESPINA M.D., F.A.C.C. (NPI 1497756076)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497756076 NPI number — DARIO M ESPINA M.D., F.A.C.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ESPINA
Provider First Name:
DARIO
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D., F.A.C.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497756076
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 11768
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT SMITH
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72917-1768
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-484-1010
Provider Business Mailing Address Fax Number:
479-785-9916

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
205 E RAY FINE BLVD STE 6
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROLAND
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74954-5381
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-503-6235
Provider Business Practice Location Address Fax Number:
918-503-6239
Provider Enumeration Date:
08/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RI0011X , with the licence number:  14997 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: E1954 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 136409001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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