Provider Demographics
NPI:1235163148
Name:MACCURDY, DANIEL S (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:S
Last Name:MACCURDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 S OLD DIXIE HWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7202
Mailing Address - Country:US
Mailing Address - Phone:561-743-3065
Mailing Address - Fax:561-743-3060
Practice Address - Street 1:1002 S OLD DIXIE HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7202
Practice Address - Country:US
Practice Address - Phone:561-743-3065
Practice Address - Fax:561-743-3060
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME53053174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL650357607OtherTAX ID NUMBER
D51846Medicare UPIN
FL07064AMedicare ID - Type Unspecified