Provider Demographics
NPI:1326253816
Name:DANIEL, JACQUES PHILIPPE (DPM)
Entity Type:Individual
Prefix:DR
First Name:JACQUES
Middle Name:PHILIPPE
Last Name:DANIEL
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 1:542 W SAGAMORE AVE STE E
Mailing Address - Street 2:
Mailing Address - City:CLEWISTON
Mailing Address - State:FL
Mailing Address - Zip Code:33440-3514
Mailing Address - Country:US
Mailing Address - Phone:863-301-3212
Mailing Address - Fax:863-301-3217
Practice Address - Street 1:542 W SAGAMORE AVE STE E
Practice Address - Street 2:
Practice Address - City:CLEWISTON
Practice Address - State:FL
Practice Address - Zip Code:33440-3514
Practice Address - Country:US
Practice Address - Phone:863-301-3212
Practice Address - Fax:863-301-3217
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2309213ES0103X
FLPO3939213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0713961Medicaid
MAY71146OtherBLUECROSS BLUESHIELD
MAY71146OtherBLUECROSS BLUESHIELD