Healthcare Provider Details

I. General information

NPI: 1982688206
Provider Name (Legal Business Name): THOMAS EDWARD DAGLISH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 04/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 W NOBLE AVE
VISALIA CA
93277-2669
US

IV. Provider business mailing address

311 W NOBLE AVE
VISALIA CA
93277-2669
US

V. Phone/Fax

Practice location:
  • Phone: 559-625-9200
  • Fax:
Mailing address:
  • Phone: 559-625-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA33194
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: