Provider Demographics
NPI:1285825240
Name:ERVIN, DANIEL MCQUEEN (MD)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:MCQUEEN
Last Name:ERVIN
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 1:1523 B HERITAGE LANE
Mailing Address - Street 2:UNIT B
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-3197
Mailing Address - Country:US
Mailing Address - Phone:843-662-7969
Mailing Address - Fax:843-662-7942
Practice Address - Street 1:1523 B HERITAGE LANE
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-3197
Practice Address - Country:US
Practice Address - Phone:843-662-7969
Practice Address - Fax:843-662-7942
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9383207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD99351Medicare UPIN