Provider Demographics
NPI:1689744591
Name:DRISCOLL, DANIEL ABRAM (MD/PHD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ABRAM
Last Name:DRISCOLL
Suffix:
Gender:M
Credentials:MD/PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 N F AVE
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:AZ
Mailing Address - Zip Code:85607-1920
Mailing Address - Country:US
Mailing Address - Phone:520-364-1429
Mailing Address - Fax:520-515-8690
Practice Address - Street 1:108 ARIZONA ST
Practice Address - Street 2:
Practice Address - City:BISBEE
Practice Address - State:AZ
Practice Address - Zip Code:85603-1804
Practice Address - Country:US
Practice Address - Phone:520-432-3309
Practice Address - Fax:520-364-4261
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO34024208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01340249Medicaid
AZ396675Medicaid