Healthcare Provider Details

I. General information

NPI: 1255393120
Provider Name (Legal Business Name): MATTHEW DANIEL DAGGETT PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 01/17/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S.TWINING ST. BLDG 760
MONTGOMERY AL
36112
US

IV. Provider business mailing address

300 TWINING ST BLDG 760
MONTGOMERY AL
36112-6027
US

V. Phone/Fax

Practice location:
  • Phone: 334-953-5273
  • Fax: 334-953-5273
Mailing address:
  • Phone: 334-953-5273
  • Fax: 334-953-5201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA-408
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: