MEDICARE: JAMES D DAUGHTRY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	ME 20583	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4520645	OTHER	FL	NONE
2	65-0223262	OTHER	FL	NONE
3	1693153	OTHER	FL	NONE
4	340007304	OTHER	FL	NONE
5	P2297823	OTHER	FL	NONE

General Provider Information

NPI Number	:	1619978335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES D DAUGHTRY MD

Provider Business Mailing Address
First Line	:	1201 NW 16TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-1624
Country	:	US
Telephone Number	:	561-801-0304
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 NW 16TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-1624
Country	:	US
Telephone Number	:	561-801-0304
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	03/08/2010

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Directions to “ JAMES D DAUGHTRY MD” Practice Location

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