Provider Demographics
NPI:1356476444
Name:DAIGLE, EDWARD EUGENE (MT)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:EUGENE
Last Name:DAIGLE
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4567 WOLF LAKE DR SE
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-7348
Mailing Address - Country:US
Mailing Address - Phone:218-333-8651
Mailing Address - Fax:218-335-3265
Practice Address - Street 1:425 7TH ST NW
Practice Address - Street 2:
Practice Address - City:CASS LAKE
Practice Address - State:MN
Practice Address - Zip Code:56633-3360
Practice Address - Country:US
Practice Address - Phone:218-335-3258
Practice Address - Fax:218-335-3265
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist