Provider Demographics
NPI:1235139007
Name:VALACH, DANIEL PESEK (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:PESEK
Last Name:VALACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1409 HIGHWAY 201 N
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-2425
Mailing Address - Country:US
Mailing Address - Phone:870-508-5010
Mailing Address - Fax:870-508-5020
Practice Address - Street 1:1409 HIGHWAY 201 N
Practice Address - Street 2:SUITE 1
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-2953
Practice Address - Country:US
Practice Address - Phone:870-508-5010
Practice Address - Fax:870-508-5020
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2013-07-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ARE3504207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0574152Medicaid
MO655772OtherHEALTHLINK
MO22179OtherCOX HEALTH SYSTEMS
AR5M511OtherARKANSAS BLUE CROSS BLUE SHIELD
AR03070018700OtherQUAL CHOICE
MO208254300Medicaid
AR149115001Medicaid
2294015OtherCIGNA
7126443OtherAETNA
2115804OtherFIRST HEALTH
72653 A002OtherTRICARE
AR5M411Medicare PIN
MO22179OtherCOX HEALTH SYSTEMS
7126443OtherAETNA