Provider Demographics
NPI:1235310657
Name:JOHN DANIEL M.D, PS, INC.
Entity Type:Organization
Organization Name:JOHN DANIEL M.D, PS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:N
Authorized Official - Last Name:DANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-845-4934
Mailing Address - Street 1:801 E MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-3365
Mailing Address - Country:US
Mailing Address - Phone:253-845-4934
Mailing Address - Fax:253-845-9289
Practice Address - Street 1:801 E MAIN STREET
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3365
Practice Address - Country:US
Practice Address - Phone:253-845-4934
Practice Address - Fax:253-845-9289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00037757207Q00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8800256Medicare PIN
WAG97703Medicare UPIN