Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | E3954 | AR |
NPI | 1366471211 |
---|---|
Provider Name | Mary Frances Daut |
First Address | Fayetteville, AR 72703-5251 |
Second Address | Fayetteville, AR 72703-5252 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2006 |
Last Update Date | 10/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
156621001 | (05) | AR |
I23922 | (02) |