Healthcare Provider Details

I. General information

NPI: 1457302895
Provider Name (Legal Business Name): DANIEL N EAD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 05/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1216 N UNIVERSITY DR
PLANTATION FL
33322-4724
US

IV. Provider business mailing address

2234 COLONIAL BLVD ATTN: PAYER CONTRACTING & RELATIONS
FORT MYERS FL
33907-1412
US

V. Phone/Fax

Practice location:
  • Phone: 954-472-4072
  • Fax: 954-472-4044
Mailing address:
  • Phone: 239-931-7342
  • Fax: 239-931-7385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberME87145
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: