Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | E2474 | AR |
Y | 111NI0900X | Internist | E2474 | AR |
N | 207RA0401X | Internist - Addiction Medicine | E2474 | AR |
NPI | 1750328233 |
---|---|
Provider Name | Paul Daidone |
First Address | Rogers, AR 72756-2834 |
Second Address | Rogers, AR 72756-2834 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2006 |
Last Update Date | 22/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
141472001 | (05) | AR |
H19953 | (02) | AR |