Provider Demographics
NPI:1801815303
Name:JUERGENS, DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:JUERGENS
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 1:89 SYLVANIA DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45440-3281
Mailing Address - Country:US
Mailing Address - Phone:937-320-2020
Mailing Address - Fax:937-320-0504
Practice Address - Street 1:89 SYLVANIA DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45440-3281
Practice Address - Country:US
Practice Address - Phone:937-320-2020
Practice Address - Fax:937-320-0504
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35038872J174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000005856OtherANTHEM
OH0362932Medicaid
OH1801815303OtherNPI
OH0820025OtherUNITED HEATHCARE
OH180009207OtherMEDICARE RAILROAD
OH180009207OtherMEDICARE RAILROAD
OH1801815303OtherNPI
OH000000005856OtherANTHEM
OH0448384Medicare PIN