Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 143025 | AK |
N | 207RG0300X | Geriatric Medicine | 67210 | WI |
NPI | 1114313434 |
---|---|
Provider Name | Dr. Daniel Joel Mcculley |
First Address | Fairbanks, AK 99701-4991 |
Second Address | Fairbanks, AK 99701-4991 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2015 |
Last Update Date | 24/02/2020 |