Provider Demographics
NPI:1669979837
Name:DEMICK, DANIEL S (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:S
Last Name:DEMICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:105 KRISTI DR
Mailing Address - Street 2:
Mailing Address - City:INDIAN HARBOUR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-4106
Mailing Address - Country:US
Mailing Address - Phone:740-649-6147
Mailing Address - Fax:
Practice Address - Street 1:740 MACE RD
Practice Address - Street 2:
Practice Address - City:PATRICK AFB
Practice Address - State:FL
Practice Address - Zip Code:32925-3616
Practice Address - Country:US
Practice Address - Phone:304-691-1500
Practice Address - Fax:304-523-4358
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-12
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME1705012084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry