Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | CH00003299 | FL |
NPI | 1053518845 |
---|---|
Provider Name | Daniel Joseph Madock |
First Address | Temple Terrace, FL 33617-2237 |
Second Address | Temple Terrace, FL 33617-2237 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2007 |
Last Update Date | 14/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
380679100 | (05) | FL |
88417 | (02) | FL |