Provider Demographics
NPI:1821179755
Name:DANIELSON, DAVID B (DPM)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:B
Last Name:DANIELSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14580 TAMIAMI TRL UNIT H
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34287-2708
Mailing Address - Country:US
Mailing Address - Phone:941-429-1702
Mailing Address - Fax:941-429-0981
Practice Address - Street 1:14580 TAMIAMI TRL UNIT H
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-2708
Practice Address - Country:US
Practice Address - Phone:941-429-1702
Practice Address - Fax:941-429-0981
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 3256213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU8683Medicare PIN
FLV06159Medicare UPIN
FL5553370003Medicare NSC
FLU8683YMedicare PIN