Provider Demographics
NPI:1831112853
Name:RHEUARK, DARYL ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:DARYL
Middle Name:ROBERT
Last Name:RHEUARK
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 1:24520 HAWTHORNE BLVD.
Mailing Address - Street 2:SUITE 240
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-6849
Mailing Address - Country:US
Mailing Address - Phone:310-373-8777
Mailing Address - Fax:310-373-5806
Practice Address - Street 1:24520 HAWTHORNE BLVD.
Practice Address - Street 2:SUITE 240
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-6849
Practice Address - Country:US
Practice Address - Phone:310-373-8777
Practice Address - Fax:310-373-5806
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG75449207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW8594Medicare ID - Type Unspecified
G37239Medicare UPIN