Provider Demographics
NPI:1538112636
Name:DAFLER, PHIL S (MD)
Entity Type:Individual
Prefix:
First Name:PHIL
Middle Name:S
Last Name:DAFLER
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 1:14861 STATE ROUTE 30
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953-4816
Mailing Address - Country:US
Mailing Address - Phone:518-483-0065
Mailing Address - Fax:518-483-0809
Practice Address - Street 1:14861 STATE ROUTE 30
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-4816
Practice Address - Country:US
Practice Address - Phone:518-483-0065
Practice Address - Fax:518-483-0809
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-058291207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0760903Medicaid
P00363925OtherRAILROAD MEDICARE
NY02808684Medicaid
NY02808684Medicaid
OH0637239Medicare ID - Type Unspecified
OH0760903Medicaid
P00363925OtherRAILROAD MEDICARE
NY0693520001Medicare NSC