1588636070 NPI number — STEPHEN DARRELL DANIEL M.D.

Table of content: STEPHEN DARRELL DANIEL M.D. (NPI 1588636070)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588636070 NPI number — STEPHEN DARRELL DANIEL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DANIEL
Provider First Name:
STEPHEN
Provider Middle Name:
DARRELL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1588636070
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 966
Provider Second Line Business Mailing Address:
NORTON SOUND HEALTH CORPORATION
Provider Business Mailing Address City Name:
NOME
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99762-0966
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-443-3407
Provider Business Mailing Address Fax Number:
907-443-4570

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 GREG KRUSCHEK AVE.
Provider Second Line Business Practice Location Address:
NORTON SOUND HEALTH CORPORATION
Provider Business Practice Location Address City Name:
NOME
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99762-0966
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-443-3311
Provider Business Practice Location Address Fax Number:
907-443-4570
Provider Enumeration Date:
02/07/2006

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: 207Q00000X , with the licence number:  5318 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: MD2962 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".




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