Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | IL |
NPI | 1083609655 |
---|---|
Provider Name | Dr. Daniel Paul Naughton |
First Address | Belleville, IL 62221-2595 |
Second Address | Scott Afb, IL 62225-5250 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OTH000 | (02) |