Healthcare Provider Details

I. General information

NPI: 1033370952
Provider Name (Legal Business Name): J DANIEL LABS MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2008
Last Update Date: 10/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 GOODLETTE RD N SUITE 205
NAPLES FL
34102-5656
US

IV. Provider business mailing address

720 GOODLETTE RD N SUITE 205
NAPLES FL
34102-5656
US

V. Phone/Fax

Practice location:
  • Phone: 239-649-4263
  • Fax:
Mailing address:
  • Phone: 239-649-4263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License NumberME0061579
License Number StateFL

VIII. Authorized Official

Name: DR. JOSEPH D LABS
Title or Position: OWNER
Credential: MD
Phone: 239-649-4263