Provider Demographics
NPI:1437201639
Name:DAIGLER, GERALD (MD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:
Last Name:DAIGLER
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 1:12508 MORTONS CORNERS RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14141-9788
Mailing Address - Country:US
Mailing Address - Phone:716-592-2443
Mailing Address - Fax:
Practice Address - Street 1:1405 SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14211-3337
Practice Address - Country:US
Practice Address - Phone:716-816-4462
Practice Address - Fax:716-897-8158
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104572208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1203736OtherIHA
NERA2357Medicare ID - Type Unspecified