Provider Demographics
NPI:1972740595
Name:MESSER, DANIEL SHANE (IDC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:SHANE
Last Name:MESSER
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USS SPRINGFIELD
Mailing Address - Street 2:SSN 761
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09587-2417
Mailing Address - Country:US
Mailing Address - Phone:860-694-3898
Mailing Address - Fax:860-694-3871
Practice Address - Street 1:USS SPRINGFIELD
Practice Address - Street 2:SSN 761
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09587-2417
Practice Address - Country:US
Practice Address - Phone:860-694-3898
Practice Address - Fax:860-694-3871
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-20
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman