Provider Demographics
NPI:1326595877
Name:WILLIAMSON, DANIEL (IDC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:WILLIAMSON
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USS MICHAEL MURPHY
Mailing Address - Street 2:UNIT 100229 BOX 1
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96672
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:USS MICHAEL MURPHY
Practice Address - Street 2:UNIT 100229 BOX 1
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96672
Practice Address - Country:US
Practice Address - Phone:808-473-0230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman