Provider Demographics
NPI:1952476350
Name:WAYMAN, DANIEL MAC DOWELL (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:MAC DOWELL
Last Name:WAYMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DANIEL
Other - Middle Name:MAC DOWELL
Other - Last Name:WAYMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:555 BLACK OAK DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8447
Mailing Address - Country:US
Mailing Address - Phone:541-734-3540
Mailing Address - Fax:541-734-3597
Practice Address - Street 1:555 BLACK OAK DR
Practice Address - Street 2:SUITE 210
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8447
Practice Address - Country:US
Practice Address - Phone:541-734-3540
Practice Address - Fax:541-734-3597
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD17390207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR931274301OtherTAX ID
OR027792Medicaid
ORMD17390OtherMEDICAL LIC OR
OR4004301-01OtherBLUE CROSS
CAG62052OtherMEDICAL LIC CALIF
CAXPY124720OtherMEDICAL ID
CAXPY124720OtherMEDICAL ID
OR104912Medicare ID - Type UnspecifiedMEDICAR
CAG62052OtherMEDICAL LIC CALIF
OR027792Medicaid