Provider Demographics
NPI:1588636070
Name:DANIEL, STEPHEN DARRELL (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:DARRELL
Last Name:DANIEL
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 966
Mailing Address - Street 2:NORTON SOUND HEALTH CORPORATION
Mailing Address - City:NOME
Mailing Address - State:AK
Mailing Address - Zip Code:99762-0966
Mailing Address - Country:US
Mailing Address - Phone:907-443-3407
Mailing Address - Fax:907-443-4570
Practice Address - Street 1:1000 GREG KRUSCHEK AVE.
Practice Address - Street 2:NORTON SOUND HEALTH CORPORATION
Practice Address - City:NOME
Practice Address - State:AK
Practice Address - Zip Code:99762-0966
Practice Address - Country:US
Practice Address - Phone:907-443-3311
Practice Address - Fax:907-443-4570
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AK5318207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD2962Medicaid
G32191Medicare UPIN
AKMD2962Medicaid