Basic Information
| Provider Information | |||||||||
| NPI: | 1417301417 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ADAMS | ||||||||
| FirstName: | SHAUN | ||||||||
| MiddleName: | DANIEL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1341 N FUTRALL DR | ||||||||
| Address2: | APARTMENT 4 | ||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727031172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016264477 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2710 S RIFE MEDICAL LN | ||||||||
| Address2: | |||||||||
| City: | ROGERS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727581452 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4793388000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2016 | ||||||||
| LastUpdateDate: | 08/09/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | E-12093 | AR | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.