Provider Demographics
NPI:1558378778
Name:CARUSO, DANIEL RAYMOND (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:RAYMOND
Last Name:CARUSO
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:PO BOX 18537
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-0537
Mailing Address - Country:US
Mailing Address - Phone:775-287-2625
Mailing Address - Fax:775-996-4116
Practice Address - Street 1:5605 RIGGINS CT
Practice Address - Street 2:SUITE 206
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-6501
Practice Address - Country:US
Practice Address - Phone:775-287-2625
Practice Address - Fax:775-996-4116
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7092207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
E65505Medicare UPIN
46WCHGQ04Medicare ID - Type Unspecified