Provider Demographics
NPI:1528564564
Name:ISAAC, DANIEL EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:EDWARD
Last Name:ISAAC
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 1:1851 MESQUITE AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5681
Mailing Address - Country:US
Mailing Address - Phone:928-854-0094
Mailing Address - Fax:928-680-8986
Practice Address - Street 1:1851 MESQUITE AVE STE 202
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5681
Practice Address - Country:US
Practice Address - Phone:928-854-0094
Practice Address - Fax:928-680-8986
Is Sole Proprietor?:No
Enumeration Date:2018-03-30
Last Update Date:2021-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AZ63290207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program