Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 24565 | WV |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 34176 | AL |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 35.123634 | OH |
N | 208200000X | Surgeon | R9794 | AL |
N | 208600000X | Surgeon | R9794 | AL |
NPI | 1215198007 |
---|---|
Provider Name | Justin L Daigre |
First Address | Decatur, AL 35601-3595 |
Second Address | Decatur, AL 35601-3595 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2008 |
Last Update Date | 13/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
102I708313 | MEDICARE PTAN (01) | AL |
172883 | (05) | AL |