Provider Demographics
NPI:1821076431
Name:ROSSIGNOL, DANIEL A (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:A
Last Name:ROSSIGNOL
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 1:2340 DAIRY RD
Mailing Address - Street 2:
Mailing Address - City:WEST MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-5210
Mailing Address - Country:US
Mailing Address - Phone:321-259-7111
Mailing Address - Fax:949-407-7652
Practice Address - Street 1:2340 DAIRY RD
Practice Address - Street 2:
Practice Address - City:WEST MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-5210
Practice Address - Country:US
Practice Address - Phone:321-259-7111
Practice Address - Fax:949-407-7652
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101058228207Q00000X
FLME97209207Q00000X
CAC54759207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H23767Medicare UPIN