Provider Demographics
NPI:1417959123
Name:BOSS, DANIEL L (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:L
Last Name:BOSS
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 1:600 UNIVERSITY BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-2778
Mailing Address - Country:US
Mailing Address - Phone:561-748-1888
Mailing Address - Fax:561-629-5560
Practice Address - Street 1:600 UNIVERSITY BLVD STE 105
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-2778
Practice Address - Country:US
Practice Address - Phone:561-748-1888
Practice Address - Fax:561-629-5560
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2021-02-24
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
FLME81918207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH36395Medicare UPIN
FL58810Medicare ID - Type Unspecified