Provider Demographics
NPI:1457302895
Name:EAD, DANIEL N (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:N
Last Name:EAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:1216 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-4724
Practice Address - Country:US
Practice Address - Phone:954-472-4072
Practice Address - Fax:954-472-4044
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87145208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7971556OtherAETNA
FLP1003965OtherFREEDOM
FLPRL00000269421OtherPREFERRED MEDICAL PLAN (COMM. & MEDICARE ONLY)
FLP01392071OtherRR MEDICARE
FL2294982OtherUNITED
FLP957358OtherOPTIMUM
FL1193008OtherWELLCARE
FLPRL00000269421OtherPREFERRED MEDICAL PLAN (COMM. & MEDICARE ONLY)
FL7971556OtherAETNA