Provider Demographics
NPI:1952560807
Name:DANIEL S MACCURDY MD PA
Entity Type:Organization
Organization Name:DANIEL S MACCURDY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:MACCURDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-743-3065
Mailing Address - Street 1:1002 S OLD DIXIE HWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7202
Mailing Address - Country:US
Mailing Address - Phone:561-743-3065
Mailing Address - Fax:561-743-3060
Practice Address - Street 1:1002 S OLD DIXIE HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7202
Practice Address - Country:US
Practice Address - Phone:561-743-3065
Practice Address - Fax:561-743-3060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME53053174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL048593400Medicaid
FL048593400Medicaid