Healthcare Provider Details

I. General information

NPI: 1457384497
Provider Name (Legal Business Name): DANIEL C DAUBE JR MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 08/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 DOCTORS DR
PANAMA CITY FL
32405-4559
US

IV. Provider business mailing address

200 DOCTORS DR
PANAMA CITY FL
32405-4559
US

V. Phone/Fax

Practice location:
  • Phone: 850-784-7722
  • Fax: 850-784-6903
Mailing address:
  • Phone: 850-784-7722
  • Fax: 850-784-6903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: DR. DANIEL CAMPBELL DAUBE JR.
Title or Position: MEMBER
Credential: M.D.
Phone: 850-784-7722