Provider Demographics
NPI:1780692079
Name:DAIGLE, ANDREW P (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:P
Last Name:DAIGLE
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 1:4266 SUNBEAM RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-2425
Mailing Address - Country:US
Mailing Address - Phone:904-407-7700
Mailing Address - Fax:904-407-6001
Practice Address - Street 1:4266 SUNBEAM RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-2425
Practice Address - Country:US
Practice Address - Phone:904-407-7700
Practice Address - Fax:904-407-6001
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME61517207P00000X
SC13573207Q00000X
AL27686207Q00000X
VA0101246311207QH0002X
FL61517207QH0002X
TN56034207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC203013OtherMEDCOST
NC5908498Medicaid
SC7227499OtherAETNA
VAC06778OtherGROUP PTAN
SC135730Medicaid
SC135730Medicaid
SCB92575Medicare UPIN
SCAA2421Medicare PIN