Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QS0010X | Family Doctor - Sports Medicine | MD467809 | PA |
NPI | 1295094431 |
---|---|
Provider Name | Eldra W Daniels |
First Address | Hershey, PA 17033-0858 |
Second Address | Mount Joy, PA 17552-8803 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2012 |
Last Update Date | 19/06/2019 |