Healthcare Provider Details

I. General information

NPI: 1982689899
Provider Name (Legal Business Name): DANIEL L ROPER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 11/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 MEIGS DR
SHALIMAR FL
32579-2145
US

IV. Provider business mailing address

59 MEIGS DR
SHALIMAR FL
32579-2145
US

V. Phone/Fax

Practice location:
  • Phone: 850-585-1594
  • Fax: 850-651-8782
Mailing address:
  • Phone: 850-585-1594
  • Fax: 850-651-8782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME34746
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: