1699778407 NPI number — DR. DANNY J AQUILAR DPM

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699778407 NPI number — DR. DANNY J AQUILAR DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AQUILAR
Provider First Name:
DANNY
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1699778407
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/04/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2089
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RUSSELLVILLE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72811-2089
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-890-3668
Provider Business Mailing Address Fax Number:
479-890-9513

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2400 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RUSSELLVILLE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72801-2531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-890-3668
Provider Business Practice Location Address Fax Number:
479-890-9513
Provider Enumeration Date:
05/24/2005

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: 213ES0103X , with the licence number:  141 , 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: 139839717 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5375757 . This is a "AETNA INDIVIDUAL NUMBER" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 5U232 . This is a "BCBS INDIVIDUAL NUMBER" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 18514000000 . This is a "QUALCHOICE INDV. NUMBER" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 7396535001 . This is a "CIGNA INDIVIDUAL NUMBER" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 480030569 . This is a "RAILROAD MEDICARE NUMBER" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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