Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207ND0900X | Dermatopathologist | D4970 | TX |
NPI | 1174503288 |
---|---|
Provider Name | Dr. Clifton R Daniel |
First Address | Palm Beach Gardens, FL 33418-4204 |
Second Address | Arlington, TX 76012-4730 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C15002 | (02) | TX |