Provider Demographics
NPI:1295765006
Name:DANIEL BADER M.D., PA
Entity type:Organization
Organization Name:DANIEL BADER M.D., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BADER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-862-6605
Mailing Address - Street 1:928 E MAR WALT DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FT. WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547
Mailing Address - Country:US
Mailing Address - Phone:850-862-6605
Mailing Address - Fax:
Practice Address - Street 1:928 E MAR WALT DR
Practice Address - Street 2:SUITE 102
Practice Address - City:FT. WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547
Practice Address - Country:US
Practice Address - Phone:850-862-6605
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME11585207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL13408Medicare ID - Type Unspecified
FLD52248Medicare UPIN