Provider Demographics
NPI:1235164054
Name:DAINES, PAUL T (DPM)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:T
Last Name:DAINES
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 CROSSLAKE DR
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-8198
Mailing Address - Country:US
Mailing Address - Phone:812-477-1558
Mailing Address - Fax:812-488-4669
Practice Address - Street 1:225 CROSSLAKE DR
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-8198
Practice Address - Country:US
Practice Address - Phone:812-477-1558
Practice Address - Fax:812-488-4669
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ587213E00000X
IN07001080A213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ815615Medicaid
AZ815615Medicaid
AZZ114683Medicare PIN
AZP00052259Medicare PIN
AZZ75522Medicare ID - Type Unspecified