Healthcare Provider Details

I. General information

NPI: 1164430807
Provider Name (Legal Business Name): MARC HAMILTON DAOUST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 MERCY DR SUITE 300
ORLANDO FL
32808-5646
US

IV. Provider business mailing address

1037 36TH ST
ORLANDO FL
32805-7123
US

V. Phone/Fax

Practice location:
  • Phone: 407-445-6008
  • Fax:
Mailing address:
  • Phone: 407-843-8703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: