Provider Demographics
NPI:1457384497
Name:DANIEL C DAUBE JR MD LLC
Entity Type:Organization
Organization Name:DANIEL C DAUBE JR MD LLC
Other - Org Name:GULF COAST FACIAL PLASTICS & E.N.T. CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:CAMPBELL
Authorized Official - Last Name:DAUBE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:850-784-7722
Mailing Address - Street 1:200 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4559
Mailing Address - Country:US
Mailing Address - Phone:850-784-7722
Mailing Address - Fax:850-784-6903
Practice Address - Street 1:200 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4559
Practice Address - Country:US
Practice Address - Phone:850-784-7722
Practice Address - Fax:850-784-6903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207Y00000X, 207YP0228X, 207YS0123X, 207YX0007X, 207YX0602X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & NeckGroup - Multi-Specialty
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric OtolaryngologyGroup - Multi-Specialty
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Multi-Specialty
No207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic AllergyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME0068517OtherFLORIDA MEDICAL LICENSE
FLF36114Medicare UPIN
FLME0068517OtherFLORIDA MEDICAL LICENSE