Provider Demographics
NPI:1922462597
Name:GARBIN DI LUCA, DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:GARBIN DI LUCA
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:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-362-6908
Mailing Address - Fax:314-747-3258
Practice Address - Street 1:517 S EUCLID AVE
Practice Address - Street 2:DIV NEUROLOGY MOVEMENT DISORDERS, LL
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1007
Practice Address - Country:US
Practice Address - Phone:314-362-6908
Practice Address - Fax:314-747-3258
Is Sole Proprietor?:No
Enumeration Date:2016-04-11
Last Update Date:2024-04-25
Deactivation Date:2017-01-05
Deactivation Code:
Reactivation Date:2017-02-06
Provider Licenses
StateLicense IDTaxonomies
MO20220401362084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology