Provider Demographics
NPI:1669470423
Name:DANIELS, LARKIN JEFFREY (MD)
Entity Type:Individual
Prefix:
First Name:LARKIN
Middle Name:JEFFREY
Last Name:DANIELS
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 1:1855 SPRINGHILL AVE
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36607-2301
Mailing Address - Country:US
Mailing Address - Phone:251-471-3544
Mailing Address - Fax:251-476-7254
Practice Address - Street 1:1855 SPRINGHILL AVE
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36607-2301
Practice Address - Country:US
Practice Address - Phone:251-471-3544
Practice Address - Fax:251-476-7254
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00024489208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051551856Medicaid
AL515-10053OtherBLUE CROSS BLUE SHIELD
H61236Medicare UPIN
51551856Medicare ID - Type Unspecified