Provider Demographics
NPI:1255393120
Name:DAGGETT, MATTHEW DANIEL (PA)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:DANIEL
Last Name:DAGGETT
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 TWINING ST
Mailing Address - Street 2:BLDG 760
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36112-6027
Mailing Address - Country:US
Mailing Address - Phone:334-953-5273
Mailing Address - Fax:334-953-5201
Practice Address - Street 1:300 S.TWINING ST.
Practice Address - Street 2:BLDG 760
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36112
Practice Address - Country:US
Practice Address - Phone:334-953-5273
Practice Address - Fax:334-953-5273
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA-408363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
102I973407Medicare PIN
ALQ44606Medicare UPIN