Provider Demographics
NPI:1134192214
Name:DANIEL, GREGORY STEPHEN (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:STEPHEN
Last Name:DANIEL
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 1:3240 S FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-4574
Mailing Address - Country:US
Mailing Address - Phone:863-701-2470
Mailing Address - Fax:863-701-2474
Practice Address - Street 1:3240 S FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-4574
Practice Address - Country:US
Practice Address - Phone:863-701-2470
Practice Address - Fax:863-701-2474
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 49371207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine