Provider Demographics
NPI:1700879749
Name:SACKS, DANIEL NOAH (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:NOAH
Last Name:SACKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 923
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33425-0923
Mailing Address - Country:US
Mailing Address - Phone:561-228-1330
Mailing Address - Fax:561-598-7154
Practice Address - Street 1:3199 LAKE WORTH RD STE B1
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461-3652
Practice Address - Country:US
Practice Address - Phone:561-228-1330
Practice Address - Fax:561-598-7154
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0080828207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259239800Medicaid
FLH23157Medicare UPIN
FLE4455BMedicare ID - Type Unspecified