Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 5101013144 | MI |
NPI | 1003800350 |
---|---|
Provider Name | Dr. Antony James Daros |
First Address | Grand Blanc, MI 48439-2442 |
Second Address | Grand Blanc, MI 48439-2442 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2005 |
Last Update Date | 05/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4613396 | (05) | MI |
H08353 | (02) |