Healthcare Provider Details

I. General information

NPI: 1689744591
Provider Name (Legal Business Name): DANIEL ABRAM DRISCOLL MD/PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 ARIZONA ST
BISBEE AZ
85603-1804
US

IV. Provider business mailing address

1205 N F AVE
DOUGLAS AZ
85607-1920
US

V. Phone/Fax

Practice location:
  • Phone: 520-432-3309
  • Fax: 520-364-4261
Mailing address:
  • Phone: 520-364-1429
  • Fax: 520-515-8690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34024
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: