Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 01034603 | IN |
Y | 208600000X | Surgeon | 01034603 | IN |
N | 2082S0105X | Plastic Hand Surgeon | 01034603A | IN |
NPI | 1104966720 |
---|---|
Provider Name | Dr. John R. Danielson |
First Address | Merrillville, IN 46410-5303 |
Second Address | Merrillville, IN 46410-5303 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2007 |
Last Update Date | 03/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000095467 | ANTHEM (01) | |
100201750A | (05) | IN |
240000555 | RAILROAD MEDICARE (01) | IN |
C-25467 | (02) |