Provider Demographics
NPI:1083970198
Name:BOX, DANIEL
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:BOX
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 BERYWOOD TRL NW STE B
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-5288
Mailing Address - Country:US
Mailing Address - Phone:423-472-3201
Mailing Address - Fax:423-476-4949
Practice Address - Street 1:400 BERYWOOD TRL NW STE B
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-5288
Practice Address - Country:US
Practice Address - Phone:423-472-3201
Practice Address - Fax:423-476-4949
Is Sole Proprietor?:No
Enumeration Date:2012-04-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD56133208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology