Provider Demographics
NPI:1952305914
Name:IGWE, DANIEL JR (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:IGWE
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:1225 E LATHAM AVE
Mailing Address - Street 2:#A
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-4423
Mailing Address - Country:US
Mailing Address - Phone:951-929-6260
Mailing Address - Fax:951-765-2855
Practice Address - Street 1:2390 E FLORIDA AVE
Practice Address - Street 2:#103
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92544-4707
Practice Address - Country:US
Practice Address - Phone:951-766-0374
Practice Address - Fax:951-766-0601
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-08
Last Update Date:2012-11-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NM2002-0051208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NME87963Medicare UPIN
CADA020AMedicare PIN