Provider Demographics
NPI:1881031730
Name:THOUVENOT, DANIEL JOSEPH (DPM)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:JOSEPH
Last Name:THOUVENOT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5139 MATTIS RD STE 102
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2250
Mailing Address - Country:US
Mailing Address - Phone:314-909-1920
Mailing Address - Fax:314-909-1980
Practice Address - Street 1:784 WALL ST STE C
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-2088
Practice Address - Country:US
Practice Address - Phone:618-236-7444
Practice Address - Fax:618-726-2662
Is Sole Proprietor?:No
Enumeration Date:2013-06-02
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016.005683213ES0103X
MO2013033616213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery