Provider Demographics
NPI:1477561843
Name:IRIZARRY, DANIEL JASON (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JASON
Last Name:IRIZARRY
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 1:13546 PHOENIX DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-9340
Mailing Address - Country:US
Mailing Address - Phone:407-494-8154
Mailing Address - Fax:
Practice Address - Street 1:460 E ALTAMONTE DR STE 2200
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-4653
Practice Address - Country:US
Practice Address - Phone:407-767-0009
Practice Address - Fax:407-767-0022
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00022499207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine